CPT code 43450 is used for the procedure of dilating the esophagus, either once or multiple times, to treat narrowing or blockages.
CPT code 43450 is used to describe the procedure of dilating the esophagus using one or multiple passes. This procedure is typically performed to treat conditions that cause narrowing or strictures in the esophagus, allowing for improved passage of food and liquids. The code indicates that the dilation is done through a non-surgical method, often utilizing specialized instruments to widen the esophageal lumen.
For CPT code 43450, which pertains to the dilation of the esophagus with one or multiple passes, 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 26 - Professional Component: Indicates that the service provided was the professional component, such as the interpretation of a diagnostic test.
3. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Indicates that multiple procedures were performed during the same session.
5. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. 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.
7. 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.
8. Modifier 76 - Repeat Procedure 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 a different 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: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
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: Indicates that an assistant surgeon was required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these healthcare professionals assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43450 is reimbursed by Medicare. This code is included in the Medicare Physician Fee Schedule (MPFS), which means it is eligible for payment under Medicare Part B. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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