CPT code 43500 is a medical billing code used for the surgical opening of the stomach, helping healthcare providers document and bill for the procedure.
CPT code 43500 is the code used to describe the surgical procedure involving the opening of the stomach. This procedure may be performed for various medical reasons, such as to access the stomach for further treatment or to relieve obstructions. It is typically indicated in cases where other less invasive methods have failed or are not appropriate.
For CPT code 43500 (Surgical opening of stomach), 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 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
11. 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.
12. 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.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
15. 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.
16. 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 appropriately to ensure accurate billing and reimbursement.
CPT code 43500 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 your area. Providers should consult their local MAC for specific coverage and payment guidelines related to this CPT code.
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