CPT code 43620 is for the surgical removal of the stomach, a procedure often related to treating severe obesity or stomach diseases.
CPT code 43620 is for the surgical procedure involving the removal of the stomach, also known as a total gastrectomy. This procedure is typically performed to treat conditions such as stomach cancer or severe obesity. During the operation, the entire stomach is excised, and the remaining portion of the digestive tract is reconnected to allow for continued digestion.
For CPT code 43620, which pertains to the removal of the stomach, 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. This could be due to complications or additional work during the procedure.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session. This helps in indicating that the removal of the stomach was one of several procedures.
3. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if the full extent of the stomach removal was not necessary.
4. Modifier 53 - Discontinued Procedure
- Applied when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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. This is important if the removal of the stomach is performed in conjunction with other procedures that are not typically bundled together.
6. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. This might be relevant if the complexity of the stomach removal requires the expertise of two surgeons.
7. Modifier 66 - Surgical Team
- Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel. This could be applicable in cases where the removal of the stomach is part of a larger, more complex surgical intervention.
8. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same physician performs a procedure or service more than once on the same day. This might be relevant if the removal of the stomach needs to be revisited within the same day for any reason.
9. Modifier 77 - Repeat Procedure by Another Physician
- Used when a procedure or service is repeated by another physician on the same day. This could be relevant if another surgeon needs to intervene after the initial procedure.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Applied when the patient needs to return to the operating room for a related procedure during the postoperative period. This might be necessary if complications arise after the initial stomach removal.
11. 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 of the initial procedure. This could be relevant if the patient requires an unrelated surgery after the stomach removal.
12. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required during the procedure. This might be relevant if the complexity of the stomach removal necessitates additional surgical assistance.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when an assistant surgeon is required for a minimal portion of the procedure. This could be applicable if the assistant's involvement is limited but necessary.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available. This might be relevant in teaching hospitals or similar settings.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a non-physician practitioner assists in the surgery. This could be relevant if a physician assistant or nurse practitioner is involved in the stomach removal procedure.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate representation of the services provided.
CPT code 43620 is reimbursed by Medicare. The reimbursement rate for this code is determined by the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage guidelines and payment rates, as these may vary by region.
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