CPT code 43331 is a medical billing code used to describe a thoracic esophagomyotomy procedure for healthcare providers.
CPT code 43331 is used to describe a surgical procedure known as thoracic esophagomyotomy. This procedure involves making an incision in the esophagus to relieve obstruction or to treat conditions such as achalasia, where the esophagus has difficulty moving food into the stomach. The surgery is performed in the thoracic cavity, which is the part of the body that houses the lungs and heart, and it aims to improve the passage of food by cutting the muscle fibers of the esophagus.
For CPT code 43331 (Esophagomyotomy thoracic), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform a complex procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
10. 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 patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these healthcare professionals assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43331 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. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in your area.
To verify if CPT code 43331 is reimbursed, you should:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database to see if CPT code 43331 is listed and to review the associated reimbursement rate.
2. Consult Your MAC: Review any local coverage determinations (LCDs) or policies issued by your regional MAC, as these can provide additional guidance on coverage specifics.
By following these steps, you can ascertain whether CPT code 43331 is eligible for reimbursement under Medicare.
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 43331. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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