CPT code 43332 is a medical billing code for a transabdominal esophageal hiatal hernia repair procedure.
CPT code 43332 is for a transabdominal approach to repair a hiatal hernia. This procedure involves accessing the esophagus through the abdomen to correct the hernia, which occurs when part of the stomach pushes through the diaphragm into the chest cavity. The code specifically indicates that the repair is performed using a transabdominal technique, which is often chosen for its effectiveness in addressing the hernia and minimizing complications.
For CPT code 43332 (Transabdominal esophageal hiatal hernia repair), the following modifiers may be applicable:
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: 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 discontinued 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 highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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 related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
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 non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines to ensure accurate billing and reimbursement.
When considering whether the CPT code 43332 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To determine if CPT code 43332 is reimbursed, you would need to check the current MPFS to see if this specific code is listed and what the reimbursement rate is. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific guidelines or local coverage determinations (LCDs) that affect reimbursement for this code.
In summary, to confirm if CPT code 43332 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific coverage policies or restrictions.
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