CPT code 43635 is for the surgical removal of a partial section of the stomach, commonly used in bariatric procedures.
CPT code 43635 is for the surgical procedure involving the removal of a partial section of the stomach. This procedure is typically performed to treat conditions such as stomach cancer, severe obesity, or other gastrointestinal disorders. It involves excising a portion of the stomach to improve the patient's health and quality of life.
For CPT code 43635, "Removal of stomach partial," 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 factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than what is typically described by the CPT code.
3. Modifier 53 - Discontinued Procedure
- This modifier is used when the 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
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly relevant if multiple procedures are performed that are not typically reported together.
5. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons are required to perform the procedure together, each serving as a primary surgeon for a distinct part of the surgery.
6. Modifier 66 - Surgical Team
- This modifier is used when a complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
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
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
9. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if an assistant surgeon is required for a minimal portion of the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers provides additional context and specificity to the billing and coding process, ensuring accurate representation of the services provided and facilitating appropriate reimbursement.
The CPT code 43635, which involves the removal of a portion of the stomach, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide region-specific information regarding reimbursement policies and rates for CPT code 43635.
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