CPT code 43351 is a medical billing code used for the surgical opening of the esophagus, helping healthcare providers document and bill for the procedure.
CPT code 43351 is used to describe a surgical procedure involving the creation of an opening in the esophagus. This procedure may be performed to facilitate access for further treatment or to manage conditions affecting the esophagus, such as strictures or obstructions. It is typically indicated in cases where other less invasive methods have failed or are not appropriate.
For CPT code 43351 (Surgical opening esophagus), 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 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 single reportable 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 the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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 a minimum assistant surgeon is 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: Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances surrounding the surgical procedure. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 43351 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as geographic location and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in the provider's region. Providers should consult their local MAC for specific coverage and payment details related to CPT 43351.
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