CPT code 43335 is a medical billing code used for reporting transthoracic diaphragm hernia repair procedures.
CPT code 43335 is for the surgical procedure involving the repair of a transthoracic diaphragmatic hernia. This code specifically indicates that the hernia, which occurs when abdominal contents protrude through the diaphragm into the thoracic cavity, is being addressed through a surgical approach that involves accessing the thoracic cavity. The procedure aims to restore the normal anatomy and function of the diaphragm, preventing complications associated with the hernia.
For CPT code 43335, which pertains to transthoracic diaphragmatic hernia repair, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service
- This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team
- This modifier is applicable when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier when the same physician performs a procedure or service more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when a procedure or service is repeated by another physician on the same day.
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
- This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- This modifier is applicable when an assistant surgeon provides minimal assistance during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used 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 according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
Determining if CPT code 43335 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their respective reimbursement rates.
To verify if CPT code 43335 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or through tools provided by your MAC. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in your area.
In summary, to determine if CPT code 43335 is reimbursed by Medicare, you should:
1. Consult the Medicare Physician Fee Schedule (MPFS).
2. Review any relevant local coverage determinations (LCDs) from your Medicare Administrative Contractor (MAC).
By following these steps, you can ascertain the reimbursement status of CPT code 43335 under Medicare.
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