CPT code 43850 is a medical billing code used to describe the procedure of revising a stomach-bowel fusion in healthcare settings.
CPT code 43850 is used to describe the surgical procedure of revising a stomach-bowel fusion. This procedure typically involves correcting or modifying an existing surgical connection between the stomach and the intestines, which may have complications or issues that need to be addressed. It is often performed to improve digestive function or alleviate symptoms resulting from the initial fusion.
For the CPT code 43850 (Revise stomach-bowel fusion), 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 is carried out by a surgical team.
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 related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
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 43850 is reimbursed by Medicare. This 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 important for healthcare providers to verify coverage and reimbursement rates with their local MAC before performing this procedure.
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