CPT CODES

CPT Code 44365

CPT code 44365 is a medical billing code used for small bowel endoscopy procedures, helping healthcare providers document and bill for services accurately.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 44365

CPT code 44365 is used to describe a small bowel endoscopy procedure. This code specifically refers to the endoscopic examination of the small intestine, which is performed using a flexible tube equipped with a camera and light source. The procedure allows healthcare providers to visualize the interior of the small bowel, diagnose conditions, and potentially perform therapeutic interventions, such as biopsies or polypectomies, if necessary.

Does CPT 44365 Need a Modifier?

For CPT code 44365 (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 by Same Physician
- Use this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.

7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.

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 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
- Use this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period.

10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required during the procedure.

11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required during 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 surgery.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 44365 Medicare Reimbursement

The CPT code 44365 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 fees that Medicare pays for each service, including CPT code 44365. Additionally, reimbursement can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims. Each MAC may have different local coverage determinations (LCDs) that can affect whether and how much Medicare reimburses for CPT code 44365. Therefore, it is advisable to consult the MPFS and the relevant MAC for the most accurate and up-to-date information.

Are You Being Underpaid for 44365 CPT Code?

Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 44365, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background