CPT code 44213 is a code used to describe a laparoscopic procedure for mobilizing the spleen, serving as an add-on to other surgical services.
CPT code 44213 is used to describe a laparoscopic mobilization of the spleen as an additional procedure during a surgical operation. This code indicates that the surgeon is performing a minimally invasive technique to free the spleen from surrounding tissues, which may be necessary for access or to facilitate another surgical procedure. It is categorized as an add-on code, meaning it is used in conjunction with a primary procedure code to provide a more comprehensive description of the surgical services rendered.
For CPT code 44213, which pertains to laparoscopic mobilization of the splenic flexure as an add-on procedure, the following modifiers may be applicable:
1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. Since 44213 is an add-on code, it may not typically require this modifier, but it is important to be aware of its use in complex cases involving multiple procedures.
2. 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. It may be necessary if the splenic flexure mobilization is performed in a separate anatomical site or through a different approach than other procedures.
3. Modifier 62 (Two Surgeons): If two surgeons are required to perform distinct parts of the procedure, this modifier indicates that both surgeons are involved and each is performing a specific portion of the surgery.
4. Modifier 66 (Surgical Team): This modifier is used when a complex procedure requires the expertise of a surgical team. It indicates that multiple surgeons with different specialties are involved in the procedure.
5. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to help with the procedure. It indicates that another surgeon is assisting the primary surgeon.
6. Modifier 82 (Assistant Surgeon - When Qualified Resident Surgeon Not Available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
7. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the surgical procedure. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 44213, which is an add-on code, is reimbursed by Medicare under specific conditions. According to the Medicare Physician Fee Schedule (MPFS), add-on codes like 44213 are typically reimbursed when they are billed in conjunction with the primary procedure code. It is essential to ensure that the primary procedure is also covered and reimbursed by Medicare.
Moreover, the reimbursement for CPT code 44213 can vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and requirements for the submission and reimbursement of add-on codes. Therefore, it is advisable to consult the local MAC's policies and the MPFS to confirm the reimbursement details for CPT code 44213.
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