CPT code 43640 is a medical billing code for vagotomy and pylorus repair procedures, used to describe specific surgical interventions.
CPT code 43640 is for a surgical procedure that involves performing a vagotomy, which is the cutting of the vagus nerve to reduce acid secretion in the stomach, followed by a repair of the pylorus, the opening from the stomach into the small intestine. This procedure is typically indicated for patients with peptic ulcers or other gastrointestinal conditions where reducing stomach acid is necessary.
For CPT code 43640 (Vagotomy & pylorus repair), 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: Apply this modifier if multiple procedures were performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful if the vagotomy and pylorus repair were performed in conjunction with other unrelated procedures.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: Apply this modifier if the procedure was performed by a surgical team, which is often necessary for complex surgeries requiring multiple specialists.
6. 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 had to return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure. The assistant surgeon should report their involvement using this modifier.
8. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if an assistant surgeon was required for a minimal portion of the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
10. 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.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43640 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 associated with this procedure.
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