CPT code 43605 is a medical billing code used for a biopsy of the stomach, helping healthcare providers document and bill for this procedure.
CPT code 43605 is for a biopsy of the stomach. This procedure involves the removal of a small sample of stomach tissue for examination, typically to diagnose conditions such as ulcers, infections, or cancer. The biopsy can be performed using various techniques, often during an endoscopy, allowing healthcare providers to obtain a precise diagnosis based on the tissue analysis.
For CPT code 43605 (Biopsy of stomach), 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 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session. This helps in indicating that the biopsy was one of several procedures.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the biopsy was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the biopsy was repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the biopsy was repeated by a different physician on the same day.
7. 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 had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if the biopsy was performed during the postoperative period of another procedure but is unrelated to the initial procedure.
9. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the biopsy procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required during the biopsy procedure.
11. 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.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the biopsy was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43605 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify the reimbursement status of CPT code 43605, you should first refer to the MPFS. This resource will indicate whether the code is covered and, if so, the allowable payment amount. Additionally, your regional MAC can provide specific guidance and any local coverage determinations (LCDs) that may affect reimbursement.
In summary, to confirm if CPT code 43605 is reimbursed by Medicare, consult the MPFS and your regional MAC for the most accurate and up-to-date information.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43605. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
