CPT code 43336 is for the surgical repair of a thoracic diaphragm hernia, helping healthcare providers accurately bill for this procedure.
CPT code 43336 is for the surgical procedure involving the repair of a thoracoabdominal diaphragm hernia. This code specifically indicates that the hernia, which occurs when abdominal contents protrude through the diaphragm into the thoracic cavity, is being surgically corrected. The procedure typically involves repositioning the herniated tissue and reinforcing the diaphragm to prevent recurrence.
When billing for CPT code 43336 (Thoracoabdominal diaphragmatic 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: Indicates that multiple procedures were 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: Indicates that the procedure was started but 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: Indicates that two surgeons worked together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician subsequent to the original procedure.
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: Indicates that an unrelated procedure or service was 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: Indicates that a minimum assistant surgeon was required 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: Indicates that a non-physician practitioner assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 43336 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 covered by Medicare, along with the corresponding reimbursement rates. Each MAC may have additional local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed.
To verify if CPT code 43336 is reimbursed by Medicare, you would need to:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database to see if CPT code 43336 is listed and to review the associated reimbursement rate.
2. Consult Your MAC: Review any local coverage determinations (LCDs) or policies issued by your Medicare Administrative Contractor, as these can provide specific guidelines or restrictions related to the reimbursement of CPT code 43336.
By following these steps, you can determine if CPT code 43336 is eligible for reimbursement under Medicare.
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