CPT code 43520 is for the surgical incision of the pyloric muscle, often performed to treat gastric outlet obstruction.
CPT code 43520 is for the surgical procedure involving the incision of the pyloric muscle. This procedure is typically performed to relieve gastric outlet obstruction, allowing for improved passage of food from the stomach into the small intestine. It is often indicated in cases of hypertrophic pyloric stenosis, particularly in pediatric patients.
For CPT code 43520 (Incision of pyloric muscle), 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 increased intensity, time, technical difficulty, or physical and mental effort.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that the primary procedure is accompanied by additional procedures.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by another physician on the same day.
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
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 43520 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and the relevant Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. Additionally, the MAC for your region can offer specific guidance and any local coverage determinations (LCDs) that may affect reimbursement for CPT code 43520.
Always ensure to check these resources to confirm the most current and applicable information.
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