CPT code 44120 is for the surgical removal of a portion of the small intestine, often due to disease or obstruction.
CPT code 44120 is for the surgical procedure involving the removal of a portion of the small intestine. This code is typically used when a surgeon performs a resection of the small intestine due to conditions such as tumors, blockages, or inflammatory diseases. The procedure may involve removing a segment of the small intestine and is often necessary to address serious health issues affecting the gastrointestinal tract.
When billing for CPT code 44120 (Removal of small intestine), various modifiers may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used and the reasons for each:
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 the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Applied when the procedure is 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
- 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 team of surgeons is required to perform the procedure.
8. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by a different physician.
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 related procedure is performed during the postoperative period of the initial procedure.
11. 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.
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 practitioner assists in the surgery.
Each of these modifiers provides specific information that can affect the billing and reimbursement process for CPT code 44120. Proper use of these modifiers ensures accurate representation of the services provided and can help avoid claim denials or delays.
The CPT code 44120 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 44120. It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with Medicare's reimbursement criteria for this specific code.
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 44120. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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