CPT code 44360 is a medical billing code used for small bowel endoscopy procedures, helping healthcare providers accurately document and bill services.
CPT code 44360 is for a small bowel endoscopy, which is a procedure that allows healthcare providers to examine the inside of the small intestine using a flexible tube equipped with a camera. This code specifically refers to the endoscopic examination of the small bowel, which can help diagnose conditions such as Crohn's disease, tumors, or bleeding. The procedure may also involve taking biopsies or performing therapeutic interventions if necessary.
For CPT code 44360 (Small bowel endoscopy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed.
3. Modifier 52 - Reduced Services
- Apply this modifier when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Use this modifier 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
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier when a procedure or service is repeated by another physician or other qualified healthcare professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Apply this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required, and 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, ensuring accurate billing and reimbursement.
Determining if CPT code 44360 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Each MAC may have additional local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed.
To verify if CPT code 44360 is reimbursed, healthcare providers should:
1. Check the MPFS: Access the MPFS database to see if CPT code 44360 is listed and review the associated reimbursement rate.
2. Consult the MAC: Review any LCDs or other guidance issued by the MAC that services your region to ensure there are no additional criteria or restrictions for reimbursement.
By following these steps, healthcare providers can determine the reimbursement status of CPT code 44360 under Medicare.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 44360, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving 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
