CPT code 44206 is a medical billing code for a laparoscopic partial colectomy with stoma creation, used to describe specific surgical procedures.
CPT code 44206 is for a laparoscopic partial colectomy with the creation of a stoma. This procedure involves the surgical removal of a portion of the colon using minimally invasive techniques, specifically laparoscopy, which utilizes small incisions and a camera for guidance. The creation of a stoma refers to the surgical opening made in the abdominal wall to allow for the diversion of intestinal contents, typically when the remaining bowel cannot function normally. This code is used to document and bill for this specific surgical intervention in healthcare settings.
For CPT code 44206, "Lap part colectomy w/stoma," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
6. Modifier 66 - Surgical Team: Apply this modifier if the procedure required the services of a surgical team.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
Determining if CPT code 44206 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 44206 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, your regional MAC, which administers Medicare claims and provides local coverage determinations, can offer specific guidance on the reimbursement status of CPT code 44206.
In summary, CPT code 44206 may be reimbursed by Medicare, but confirmation requires consulting the MPFS and your regional MAC for the most accurate and up-to-date information.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 44206. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, maximizing your revenue and streamlining your financial operations.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
