CPT code 43754 is for diagnostic gastric intubation with aspiration of a specific substance, used in medical procedures.
CPT code 43754 is for the procedure of gastric intubation with aspiration of the stomach contents. This code is used when a healthcare provider inserts a tube into the stomach to remove or sample gastric fluid, often for diagnostic or therapeutic purposes.
For CPT code 43754, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 procedure.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of results.
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 threaten 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 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure was repeated by a different physician on the same day.
8. 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 needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
11. Modifier 99 - Multiple Modifiers: Use this modifier when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 43754, which involves a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 43754.
Additionally, it is crucial to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 43754 is covered and any documentation requirements that must be met. Coverage and reimbursement can vary based on local coverage determinations (LCDs) set by the MAC, so verifying with them ensures compliance and proper reimbursement.
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 43754. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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