CPT code 44316 is a medical billing code used to describe the procedure of devising a bowel pouch for patients.
CPT code 44316 is used to describe the surgical procedure of creating a bowel pouch, which is typically performed to manage conditions affecting the bowel, such as inflammatory bowel disease or after a colectomy. This procedure involves the surgical construction of a reservoir from the intestine, allowing for the collection and storage of waste, thereby improving the patient's quality of life and bowel function.
For CPT code 44316, which pertains to the creation of a bowel pouch, 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. This could occur if the full extent of the procedure was not necessary.
3. Modifier 53 - Discontinued Procedure
- This modifier is used when the procedure is started but then discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons are required to perform distinct parts of the procedure. Both surgeons must report the same CPT code with this modifier.
5. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician needs to repeat the procedure on the same day.
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.
9. 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 of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, which can be crucial for accurate billing and reimbursement.
CPT code 44316 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) in your region and any applicable local coverage determinations (LCDs). It's important to verify coverage and reimbursement with your local MAC before submitting claims for this procedure.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 44316. Schedule a demo today to see how RevFind can identify discrepancies by individual payer and ensure you receive the full reimbursement you deserve.
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
