CPT code 43659 is an unlisted laparoscopic procedure for the stomach, used when no specific code exists for the service provided.
CPT code 43659 is used to describe an unlisted laparoscopic procedure performed on the stomach. This code is utilized when a specific laparoscopic procedure does not have a designated code, allowing healthcare providers to report a unique surgical intervention that may not fit into existing categories. It is essential for accurate billing and documentation when performing complex or less common laparoscopic surgeries on the stomach.
For CPT code 43659, which pertains to an unlisted laparoscopic procedure of the stomach, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should explain why the service was reduced.
3. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient. Documentation should clearly outline the reason for discontinuation.
4. 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. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
5. Modifier 62 (Two Surgeons): This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should document their specific part of the surgery.
6. Modifier 66 (Surgical Team): This modifier is used when a team of surgeons (more than two) is required to perform a complex procedure. Documentation should support the necessity of a surgical team.
7. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial procedure.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure. Documentation should support the necessity of an assistant surgeon.
12. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required during the procedure. Documentation should support the necessity of a minimum assistant surgeon.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available. Documentation should support the necessity of an assistant surgeon and the unavailability of a resident surgeon.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery. Documentation should support the necessity of their assistance.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43659 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region.
CPT code 43659, being an unlisted procedure code, does not have a predefined reimbursement rate on the MPFS. Instead, reimbursement is typically determined on a case-by-case basis by the MAC.
Providers must submit detailed documentation and a description of the procedure performed to the MAC, which will then review the submission to decide on appropriate reimbursement.
Therefore, while CPT code 43659 can be reimbursed by Medicare, it requires additional steps and approval from the MAC.
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