CPT code 43886 is used to describe the procedure of revising an open gastric port, typically related to bariatric surgery.
CPT code 43886 is used to describe the surgical procedure of revising an existing gastric port through an open approach. This typically involves making an incision to access the gastric port, which is a site on the stomach used for feeding or other medical interventions, and making necessary adjustments or repairs to improve its function or address complications.
When using CPT code 43886, "Revise gastric port open," the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 single reportable procedure.
6. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon: When an assistant surgeon is required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Indicates the presence of an assistant surgeon for a minimal portion of the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
12. 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.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 43886, which involves a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if CPT code 43886 is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and coverage policies for various CPT codes.
Additionally, it is crucial to consult with the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide guidance on whether CPT code 43886 is covered and any specific documentation or criteria that must be met for reimbursement. Each MAC may have slightly different policies, so verifying with your regional MAC ensures compliance and accurate reimbursement.
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 43886. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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