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adutta

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My question is we are trying to bill procedure code 43281 for Laparoscopic Procedures on the Esophagus with 43775 for Laparoscopy Bariatric Surgery and or sometimes 43280 for Hiatal Hernia Repair. We need some suggestion which would be the best modifier for these code get reimbursed correctly without bundling due to the these procedures performed same time same day surgery.
 
43281 & 43280 are not billable together nor do they allow a modifier to break them apart.
43775 & 43280 are not billable together nor do they allow a modifier to break them apart.
43775 & 43281 can be billed together with the 59 modifier (or X modifier) if appropriate, keeping in mind the 59 modifier rules:
**Distinct Service - Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.

In most cases that I've come across it is not appropriate to bill these services with a 59 or X modifier.
 
From the NCCI Manual CHAPTER VI.F.10


CPT codes 43281 and 43282 describe laparoscopic paraesophageal hernia repair with fundoplasty, if performed, without or with mesh implantation respectively. These codes should not be reported for a figure-of-eight suture often performed during gastric restrictive procedures.
Click to expand...

If that is what the code is being used for then adding a modifier would be inappropriate
 
Right, and generally if the repair is being done through the same incision as the sleeve, it is not appropriate to bill w/ adding a modifier.
 
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