CPT code 44364 is a medical billing code used for small bowel endoscopy procedures, helping healthcare providers document and bill for services accurately.
CPT code 44364 is for a small bowel endoscopy, a procedure that allows healthcare providers to visually examine the small intestine using a flexible tube equipped with a camera. This code specifically indicates that the endoscopy is performed through the use of an enteroscope, which is designed to reach deeper into the small bowel than standard endoscopes. The procedure may be used for diagnostic purposes, such as identifying abnormalities, or for therapeutic interventions, such as removing polyps or treating bleeding.
For CPT code 44364 (Small bowel endoscopy), 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 unexpected findings during the endoscopy.
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 the endoscopy findings.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but 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: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the same procedure was repeated by a different physician 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: This modifier is used 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: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for 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): Use this modifier 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: This modifier is used when these non-physician practitioners assist in the surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Use this modifier for teaching situations where a resident is involved in the procedure under the supervision of a teaching physician.
15. Modifier QX - CRNA service with medical direction by a physician: This modifier is used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
16. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Apply this modifier when an anesthesiologist provides medical direction for one CRNA.
17. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Use this modifier when an anesthesiologist is directing multiple anesthesia procedures concurrently.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 44364 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) as they administer Medicare claims and can provide region-specific information regarding the reimbursement for CPT code 44364. Each MAC may have different guidelines and policies, so checking with them ensures accurate and up-to-date information.
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