CPT code 43610 is for the excision of a lesion in the stomach, detailing the specific surgical procedure for billing and documentation purposes.
CPT code 43610 is the procedure for the excision of a lesion from the stomach. This code is used when a healthcare provider surgically removes a growth or abnormal tissue from the stomach, which may be necessary for diagnostic purposes or to treat conditions such as tumors or ulcers. The excision can involve different techniques depending on the size and type of the lesion, and it is typically performed under general anesthesia.
For CPT code 43610 (Excision of stomach lesion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 52 - Reduced Services
- Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons
- When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. Modifier 66 - Surgical Team
- Used when a team of surgeons (more than two) is required to perform a specific procedure.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Indicates that a procedure or service was repeated subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Indicates that a procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Indicates that a minimum assistant surgeon was required during the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a non-physician practitioner assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43610 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 the associated reimbursement rates. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in your region.
To verify if CPT code 43610 is reimbursed, you should:
1. Check the MPFS: Access the MPFS database on the Centers for Medicare & Medicaid Services (CMS) website. Enter CPT code 43610 to see if it is listed and to review the reimbursement details.
2. Consult Your MAC: Each MAC has jurisdiction over specific geographic areas and may have unique coverage policies. Visit your MAC's website or contact them directly to confirm if CPT code 43610 is covered under their local policies.
By following these steps, you can determine if CPT code 43610 is reimbursed by Medicare in your specific region.
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