CPT code 44111 is for the surgical excision of bowel lesion(s), detailing the procedure for accurate billing and documentation in healthcare.
CPT code 44111 is for the excision of bowel lesion(s). This procedure involves the surgical removal of abnormal growths or lesions from the bowel, which may include polyps, tumors, or other pathological tissues. The excision is typically performed to diagnose or treat conditions affecting the bowel, ensuring that any potentially harmful tissue is removed to promote patient health.
For CPT code 44111 (Excision of bowel lesion(s)), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures: Indicates that multiple procedures were 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: Indicates that a 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: 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: Indicates that two surgeons worked together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
8. Modifier 76 - Repeat Procedure or Service by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was 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: Used 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: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 44111 is subject to reimbursement by Medicare, but its eligibility for payment depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining whether this specific CPT code is covered and the reimbursement rate. Healthcare providers should consult the MPFS to verify if CPT code 44111 is listed and to understand the associated payment details.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 44111 is reimbursable in your jurisdiction. They may also have Local Coverage Determinations (LCDs) that outline the conditions under which this code is covered.
In summary, while CPT code 44111 can be reimbursed by Medicare, providers must refer to the MPFS and consult their respective MACs to confirm coverage and payment specifics.
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