CPT code 43846 is a medical billing code for gastric bypass surgery performed to treat obesity.
CPT code 43846 is used to describe a surgical procedure known as gastric bypass for obesity. This procedure involves creating a small pouch from the stomach and connecting it directly to the small intestine, which helps patients achieve significant weight loss by limiting food intake and altering the digestive process. It is typically performed on individuals with severe obesity who have not had success with other weight loss methods.
For CPT code 43846 (Gastric bypass for obesity), 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 additional time and effort.
2. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
3. 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.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
6. 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.
7. 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.
8. 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.
9. 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 requires a return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the gastric bypass procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43846 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, specific coverage and reimbursement may vary depending on the Medicare Administrative Contractor (MAC) in your region. Providers should consult their local MAC for detailed guidelines and any potential coverage limitations or requirements for this procedure.
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