CPT code 44320 is a medical billing code used to describe the procedure of creating a colostomy, which is an opening in the abdomen for waste removal.
CPT code 44320 is used to describe the surgical procedure for creating a colostomy, which involves the formation of an opening (stoma) in the abdominal wall to allow for the diversion of stool from the colon. This procedure is typically performed when there is a need to bypass a diseased or damaged section of the colon, providing an alternative route for waste elimination.
For CPT code 44320 (Colostomy), the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Applied when a 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 procedure.
7. Modifier 66 - Surgical Team
- Used when a team of surgeons is required to perform the procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Applied when the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- 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 patient returns to the operating room for a related procedure during the postoperative period.
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 for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required for 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 provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the colostomy procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 44320 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, including CPT code 44320. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for this code. It is essential for healthcare providers to consult their respective MACs to understand any regional variations or additional documentation requirements that may affect the reimbursement process for CPT code 44320.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 44320. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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