CPT code 43638 is for the surgical removal of a partial section of the stomach, commonly used in bariatric procedures.
CPT code 43638 is the code used 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 43638, which pertains to the partial removal of the 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 other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be appended to indicate that more than one procedure was carried out.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: If two surgeons worked together as primary surgeons performing distinct parts of the procedure, this modifier should be used.
7. Modifier 66 - Surgical Team: Use this modifier if the procedure required the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician needs to repeat the procedure for the same patient.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician needs to repeat the procedure for the same patient.
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: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: This modifier is used if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if a PA, NP, or CNS 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 43638 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, healthcare providers should consult their respective MAC for precise information regarding the reimbursement rates and any specific coverage criteria for CPT code 43638.
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