CPT code 43865 is a medical billing code used to describe the procedure of revising a stomach-bowel fusion in healthcare settings.
CPT code 43865 is used to describe a surgical procedure that involves revising a fusion between the stomach and the bowel. This procedure may be necessary to correct complications or issues arising from a previous surgery that created this connection, ensuring proper function and health of the gastrointestinal system.
When using CPT code 43865 for revising a stomach-bowel fusion, 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 factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that the procedure was one of several performed on the same day.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than usually required.
4. Modifier 53 - Discontinued Procedure
- This modifier is used if the 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
- Apply 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.
6. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
7. Modifier 66 - Surgical Team
- This modifier is applicable if the procedure required the services of a surgical team due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician performed the procedure more than once 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 if the patient had to 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
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if an assistant surgeon provided minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 43865, which involves a specific surgical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various services covered by Medicare.
Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they provide specific guidelines and updates regarding coverage and reimbursement policies. The MACs play a crucial role in processing Medicare claims and ensuring that providers receive accurate and timely payments for the services rendered.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43865. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
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