CPT code 43840 is a medical billing code used to describe the repair of a stomach lesion in healthcare services.
CPT code 43840 is used to describe the surgical procedure for the repair of a lesion in the stomach. This code specifically indicates that a healthcare provider has performed a surgical intervention to correct or mend an abnormal area or damage within the stomach tissue. This procedure may be necessary due to various conditions, such as ulcers or tumors, and is aimed at restoring the normal function and integrity of the stomach.
For CPT code 43840 (Repair of stomach lesion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: This modifier is used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician repeats the procedure on the same day.
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: This modifier is used when the 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: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist 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 43840 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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