CPT code 44363 is for small bowel endoscopy, a procedure used to examine the small intestine for diagnostic purposes.
CPT code 44363 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 indicates that the endoscopy was performed through the use of an enteroscope, which is designed to reach deeper into the small bowel than standard endoscopes. This procedure is often utilized to diagnose conditions such as bleeding, inflammation, or tumors within the small intestine.
For CPT code 44363, which pertains to 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, such as the interpretation of results.
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 by Same Physician
- Apply this modifier when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when the same procedure is repeated by another physician subsequent to the original procedure.
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
- 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 During the Postoperative Period
- Apply this modifier when 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 when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use 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
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier when a resident performs part of the service under the supervision of a teaching physician.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Use this modifier when the physician is directing multiple anesthesia procedures concurrently.
16. Modifier QS - Monitored Anesthesia Care Service
- This modifier is used to indicate that monitored anesthesia care was provided.
17. Modifier QX - CRNA Service: With Medical Direction by a Physician
- Apply this modifier when a Certified Registered Nurse Anesthetist (CRNA) provides the service under the medical direction of a physician.
18. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Use this modifier when an anesthesiologist provides medical direction for one CRNA.
19. Modifier QZ - CRNA Service: Without Medical Direction by a Physician
- This modifier is used when a CRNA provides the service without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the small bowel endoscopy was performed, ensuring accurate billing and reimbursement.
The CPT code 44363 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 44363. Additionally, MACs can offer localized guidance and any specific requirements or documentation needed for successful reimbursement.
Always ensure to check the latest updates from both the MPFS and your MAC to stay compliant with Medicare's billing and coding policies.
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 44363. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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