CPT code 43337 is a medical billing code used for thoracic and diaphragmatic hernia repair procedures.
CPT code 43337 is used to describe a surgical procedure for the repair of a thoracoabdominal diaphragmatic hernia. This type of hernia occurs when there is an abnormal opening in the diaphragm, allowing abdominal contents to move into the thoracic cavity. The procedure involves the surgical correction of this defect to restore normal anatomical function and prevent complications associated with the hernia.
For CPT code 43337 (Thoracoabdominal diaphragmatic hernia repair), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful if another procedure was performed that is not typically reported together with 43337.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: Apply this modifier if the procedure required a surgical team due to its complexity. This indicates that multiple surgeons and/or other healthcare professionals were involved.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician had to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician had to repeat the procedure 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: Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used if an assistant surgeon was required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a non-physician provider assisted in the surgery.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43337 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 and their corresponding reimbursement rates. Each MAC may have additional local coverage determinations (LCDs) that affect whether a particular CPT code is reimbursed.
To ascertain if CPT code 43337 is reimbursed, you would need to:
1. Check the MPFS: Access the MPFS database to see if CPT code 43337 is listed and review the associated reimbursement rate.
2. Consult Your MAC: Verify with your regional MAC for any specific coverage policies or restrictions related to CPT code 43337.
By following these steps, you can determine if Medicare will reimburse for CPT code 43337.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 43337, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
