CPT code 44005 is a medical billing code used for the procedure of freeing bowel adhesions during surgery.
CPT code 44005 is used to describe the surgical procedure of freeing bowel adhesions. This involves the surgical intervention to remove or separate bands of scar tissue that have formed in the abdomen, which can cause obstruction or discomfort in the intestines. The procedure aims to restore normal bowel function and alleviate symptoms associated with these adhesions.
For CPT code 44005, "Freeing of bowel adhesion," 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 51 - Multiple Procedures: Applied when multiple procedures are 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: Applied when a procedure is terminated 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: Applied when two surgeons work 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: Applied when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is 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: Applied when a patient requires a 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: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied 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: Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 44005 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B.
For CPT code 44005, you would need to verify its status on the MPFS. Generally, if the code is listed on the MPFS with an assigned Relative Value Unit (RVU) and a payment amount, it indicates that Medicare reimburses for this service. However, reimbursement can also be influenced by local coverage determinations (LCDs) and national coverage determinations (NCDs) managed by your MAC. These determinations can specify additional criteria or limitations for reimbursement.
Therefore, to confirm if CPT code 44005 is reimbursed by Medicare, you should:
1. Check the MPFS for the specific RVU and payment amount associated with CPT code 44005.
2. Review any relevant LCDs or NCDs provided by your MAC to ensure there are no additional restrictions or requirements.
By following these steps, you can ascertain the reimbursement status of CPT code 44005 under Medicare.
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