CPT code 43825 is a medical billing code for the procedure involving the fusion of the stomach and bowel.
CPT code 43825 is used to describe a surgical procedure that involves the fusion of the stomach and bowel. This procedure typically aims to create a connection between the stomach and the intestines, which can be necessary for patients with certain gastrointestinal conditions. The fusion helps in facilitating digestion and nutrient absorption when normal pathways are compromised.
For CPT code 43825 (Fusion of stomach and bowel), 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 other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the primary procedure is accompanied by additional procedures.
3. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could be relevant if the full extent of the fusion was not required.
4. Modifier 53 - Discontinued Procedure
- Applied 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 is relevant if the fusion procedure is separate from other interventions.
6. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. This is relevant if the complexity of the fusion requires the expertise of two surgeons.
7. Modifier 66 - Surgical Team
- Used when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same physician repeats a procedure or service subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician
- Used when a procedure or service is repeated by another physician subsequent to the original procedure.
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
- Applied when a patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when an assistant surgeon is required on a minimal basis.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43825 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 43825. Each MAC may have unique guidelines and policies that influence how this code is processed and reimbursed.
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