CPT code 43634 is for the surgical removal of a partial section of the stomach, often performed to treat various medical conditions.
CPT code 43634 is for the surgical procedure involving the removal of a partial section of the stomach, typically performed to treat conditions such as cancer, ulcers, or severe obesity. This procedure may involve techniques such as laparoscopic surgery, which is minimally invasive, allowing for quicker recovery times and less postoperative pain compared to traditional open surgery.
For CPT code 43634 (Removal of stomach partial), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure 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 terminated 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 the procedure.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician 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 is 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 provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43634 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare Part B. Additionally, the reimbursement for CPT code 43634 may vary depending on the local coverage determinations (LCDs) set by the Medicare Administrative Contractor (MAC) for the region in which the service is provided. It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with all Medicare billing requirements and to determine the exact reimbursement rate for CPT code 43634.
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