CPT code 43639 is for the surgical removal of a partial section of the stomach, often performed to treat various medical conditions.
CPT code 43639 is the code used to describe the surgical procedure for the removal of a partial section of the stomach, typically performed to treat conditions such as gastric cancer or severe obesity. This procedure may involve the resection of a portion of the stomach, which can help improve the patient's overall health and quality of life by addressing underlying medical issues.
For CPT code 43639, "Removal of stomach partial," the following modifiers may be applicable:
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: Applied when 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: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. Modifier 66 - Surgical Team: Applied when a highly complex procedure is carried out by a surgical team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
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: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied 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: Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43639 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements related to this procedure.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43639. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
