CPT code 43870 is a medical billing code used to describe the procedure for repairing a stomach opening.
CPT code 43870 is used to describe the surgical procedure for repairing an opening in the stomach, often referred to as a gastrostomy. This code indicates that the healthcare provider has performed a repair to address issues such as leaks or complications arising from a previous surgical intervention or injury. The procedure typically involves closing the opening to restore normal function and prevent further complications.
For CPT code 43870 (Repair stomach opening), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 52 - Reduced Services: Indicates that 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.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by another physician or other qualified healthcare professional 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 procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 43870 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each MAC, which administers Medicare claims for specific regions, may have additional guidelines or requirements for reimbursement.
To verify if CPT code 43870 is reimbursed, you should:
1. Check the MPFS: Access the MPFS database to see if CPT code 43870 is listed and review the associated reimbursement rates and any specific conditions or limitations.
2. Consult Your MAC: Each MAC may have specific local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes. Contact your MAC or visit their website to ensure there are no additional requirements or restrictions for CPT code 43870.
By following these steps, you can determine if CPT code 43870 is reimbursed by Medicare and ensure compliance with both national and regional guidelines.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 43870. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
