CPT code 43453 is used to describe the procedure of dilating the esophagus to treat narrowing or blockages.
CPT code 43453 is used to describe the procedure of dilating the esophagus. This involves the use of a medical instrument to widen the esophagus, which may be necessary for patients experiencing narrowing or strictures that can impede swallowing or cause discomfort. The procedure is typically performed to improve the passage of food and liquids, enhancing the patient's quality of life.
For CPT code 43453 (Dilate esophagus), 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 unusual circumstances.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, typically applicable when the procedure involves both a professional and technical component.
3. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if 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
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the procedure more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure more than once 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 if the patient needs 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 the procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use 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
- This modifier is used when a non-physician practitioner assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
Determining if CPT code 43453 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. To verify if CPT code 43453 is reimbursed, you would need to check the MPFS for the specific year in question, as reimbursement rates and coverage can change annually.
Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect whether CPT code 43453 is reimbursed in your region. These LCDs provide detailed information on the conditions under which Medicare will cover certain procedures. Therefore, it is crucial to consult both the MPFS and your regional MAC's guidelines to confirm if CPT code 43453 is reimbursed by Medicare.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Imagine identifying discrepancies for specific procedures like CPT code 43453. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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
