CPT code 43644 is a medical billing code for laparoscopic gastric bypass surgery using the Roux-en-Y technique.
CPT code 43644 is used to describe a laparoscopic gastric bypass procedure, specifically the Roux-en-Y technique. This surgical intervention involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing a significant portion of the stomach and duodenum. This procedure is typically performed for weight loss in patients with obesity and related health issues, aiming to reduce food intake and nutrient absorption.
For CPT code 43644, which pertains to laparoscopic gastric bypass (Roux-en-Y), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or additional work during the procedure.
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 started but discontinued 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. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
6. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
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: Used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Indicates that an assistant surgeon was used for a portion of the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
CPT code 43644 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. Providers should consult their local MAC for specific coverage guidelines and documentation requirements to ensure proper reimbursement for this procedure.
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