CPT code 43775 is a medical billing code for lap sleeve gastrectomy, a surgical procedure for weight loss.
CPT code 43775 is for a laparoscopic sleeve gastrectomy, a surgical procedure that involves the removal of a portion of the stomach to help patients achieve weight loss. This minimally invasive technique reduces the stomach size, limiting food intake and promoting a feeling of fullness after consuming smaller meals. It is commonly performed on individuals with obesity who have not had success with other weight loss methods.
For CPT code 43775 (Lap sleeve gastrectomy), 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.
2. Modifier 51 - Multiple Procedures: Indicates that multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Indicates that a 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: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Indicates that two surgeons worked together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
8. Modifier 76 - Repeat Procedure by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician subsequent to the original procedure or service.
10. 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 patient returns to the operating room for a complication related to the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician practitioner assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43775 is reimbursed by Medicare, but it is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the reimbursement rates for this procedure, and these rates can vary based on geographic location and other factors. Additionally, Medicare Administrative Contractors (MACs) may have local coverage determinations (LCDs) that outline specific criteria for reimbursement. It is essential for healthcare providers to consult the MPFS and their respective MAC's guidelines to ensure compliance and proper reimbursement for CPT code 43775.
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