CPT code 44128 is an add-on code for enterectomy procedures, indicating additional surgical work on the intestines.
CPT code 44128 is used to describe an enterectomy procedure that involves the removal of a segment of the intestine, specifically when it is performed in conjunction with another surgical procedure. This code indicates that the enterectomy is an additional component of a more extensive surgical intervention, highlighting the complexity and the need for careful documentation in the healthcare revenue cycle management process.
For CPT code 44128, which pertains to an enterectomy as an add-on procedure, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures
- This modifier is used when multiple procedures are performed during the same surgical session. Since 44128 is an add-on code, it is typically reported in conjunction with another primary procedure, making this modifier relevant.
3. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This can be necessary to clarify that the add-on procedure is separate from the primary procedure.
4. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons are required to perform the procedure together, each acting as a primary surgeon. This is relevant in complex cases where the expertise of two surgeons is necessary.
5. Modifier 66 - Surgical Team
- This modifier is applicable when a team of surgeons is required to perform the procedure due to its complexity. It indicates that the procedure necessitated the coordinated efforts of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to perform the procedure again within a short period. This could be due to complications or the need for additional surgical intervention.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a different physician performs the repeat procedure. It helps to clarify that the subsequent procedure was necessary and performed by another provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when the procedure is unrelated to the original surgery and occurs during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help perform the procedure. It indicates that another surgeon assisted the primary surgeon during the operation.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if an assistant surgeon was present but only provided minimal assistance during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help to provide additional context and detail about the circumstances under which CPT code 44128 is used, ensuring accurate billing and reimbursement.
The CPT code 44128, which is an add-on code, is subject to reimbursement by Medicare under specific conditions. To determine if Medicare reimburses this particular CPT code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and coverage policies for various CPT codes, including add-on codes like 44128.
Additionally, it is crucial to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and coverage determinations. MACs are responsible for processing Medicare claims and can provide insights into whether CPT code 44128 is reimbursed in your specific jurisdiction. By checking both the MPFS and the relevant MAC guidelines, healthcare providers can ascertain the reimbursement status of CPT code 44128 under Medicare.
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