CPT code 43832 is used to describe the procedure for placing a gastrostomy tube in patients for nutritional support.
CPT code 43832 is used to describe the procedure of placing a gastrostomy tube. This involves the surgical insertion of a tube directly into the stomach through the abdominal wall, allowing for nutritional support and medication administration in patients who are unable to eat by mouth.
For the CPT code 43832 (Place gastrostomy tube), 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 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This might occur if the full procedure was not necessary or could not be completed.
3. Modifier 53 - Discontinued Procedure
- This modifier is used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician needs to repeat the procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician needs to repeat the procedure on the same day.
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
- This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure is unrelated to the original procedure and occurs during the postoperative period.
9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
13. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier if the procedure was performed by a resident under the supervision of a teaching physician.
14. Modifier QX - CRNA Service: With Medical Direction by a Physician
- Use this modifier if a Certified Registered Nurse Anesthetist (CRNA) provided the service under the medical direction of a physician.
15. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Apply this modifier if an anesthesiologist provided medical direction for one CRNA.
16. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Use this modifier if an anesthesiologist provided medical direction for two to four concurrent anesthesia procedures.
17. Modifier QS - Monitored Anesthesia Care Service
- This modifier is used to indicate that monitored anesthesia care (MAC) was provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43832 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 covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 43832 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific coverage policies and local coverage determinations (LCDs) that could affect reimbursement. Therefore, it is crucial to review the MAC guidelines applicable to your geographic area to ensure compliance and accurate billing.
In summary, while the MPFS and MAC guidelines are the primary resources to determine if CPT code 43832 is reimbursed by Medicare, the specific coverage and reimbursement details can vary based on regional policies and updates.
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