CPT code 43755 is for diagnostic gastric intubation with aspiration of gastric contents, used to assess stomach conditions.
CPT code 43755 is used to describe the procedure of gastric intubation with aspiration of gastric contents. This involves inserting a tube into the stomach to remove its contents, typically for diagnostic or therapeutic purposes. The procedure is often performed to relieve pressure, remove toxins, or prepare for further medical interventions.
For CPT code 43755, which pertains to diagnostic gastric intubation with aspiration of specimens, 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 procedure.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for their expertise and interpretation, not the technical component.
3. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full diagnostic intubation was not completed.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the procedure more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure more than once 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
- This modifier is used if the patient had 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 the procedure was performed during the postoperative period of another procedure but is unrelated to the original procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Use this modifier if the same laboratory test was repeated on the same day to obtain subsequent (multiple) test results.
11. Modifier 99 - Multiple Modifiers
- This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43755, which involves diagnostic gastrointestinal intubation with aspiration of specimens, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and coverage determinations. The MACs are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding the reimbursement status of CPT code 43755.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 43755. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
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
