CPT code 43756 is a medical billing code for the procedure of duodenal intubation with aspiration of a specimen.
CPT code 43756 is used to describe the procedure of intubating the duodenum, which involves inserting a tube into the duodenum (the first part of the small intestine) for the purpose of aspiration, specifically to remove fluid or other substances. This procedure is typically performed to aid in diagnosis or treatment of gastrointestinal conditions.
For CPT code 43756, which pertains to duodenal intubation with aspiration of specimens, 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 unexpected findings during the procedure.
2. Modifier 26 - Professional Component: Indicates that the service provided was the professional component only, such as the interpretation of results, and not the technical component.
3. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. 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.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure or service performed during the postoperative period was unrelated to the original procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is performed on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43756, 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 payment rates and coverage policies for various CPT codes. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 43756 is covered and the associated reimbursement rates.
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