CPT code 43774 is for laparoscopic removal of gastric band adjustments in all parts of the stomach.
CPT code 43774 is for the laparoscopic removal of a gastric band, which involves the adjustment or removal of all parts of the band that has been placed around the stomach. This procedure is typically performed when there are complications or when the band is no longer effective for weight management.
For CPT code 43774, which pertains to the laparoscopic removal of adjustable gastric banding and all associated components, 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 apply if the removal procedure is more complex due to complications or additional work.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed on the same day.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might apply if only part of the adjustable gastric banding system is removed.
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: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be necessary if the removal is performed in conjunction with another unrelated procedure.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. This could apply if the removal requires the expertise of two different surgeons.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43774 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their respective reimbursement rates.
To verify if CPT code 43774 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect reimbursement. Therefore, it is crucial to review the LCDs provided by your regional MAC to ensure compliance and confirm coverage details.
In summary, to determine if CPT code 43774 is reimbursed by Medicare, you should consult both the MPFS and the relevant MAC guidelines.
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