CPT code 43328 is a medical billing code used to describe an esophagogastric fundoplasty procedure.
CPT code 43328 is used to describe a surgical procedure known as esophagogastric fundoplasty. This procedure involves the surgical reconstruction of the esophagus and the upper part of the stomach (the fundus) to correct issues such as gastroesophageal reflux disease (GERD) or other esophageal disorders. The goal of this surgery is to strengthen the lower esophageal sphincter, thereby preventing the backflow of stomach contents into the esophagus and alleviating symptoms associated with reflux.
When billing for CPT code 43328, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
5. Modifier 66 - Surgical Team
- Used when a highly complex procedure is carried out by a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Applied when the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
Determining if CPT code 43328 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 43328 is reimbursed, you would need to check the MPFS database for the specific code.
Additionally, your MAC may have specific guidelines or policies that affect reimbursement for this code.
It is essential to review both the MPFS and any local coverage determinations (LCDs) issued by your MAC to ensure accurate and up-to-date information regarding the reimbursement status of CPT code 43328.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43328. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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