CPT code 44372 is a medical billing code used for small bowel endoscopy procedures, helping healthcare providers document and bill for services accurately.
CPT code 44372 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 is performed through the use of an enteroscope, which is designed to reach deeper into the small bowel than standard endoscopes. This procedure can be used for diagnostic purposes, such as identifying sources of bleeding, inflammation, or tumors, as well as for therapeutic interventions like removing polyps or taking biopsies.
For CPT code 44372 (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 increased complexity or time.
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 results by a physician.
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
- Apply this modifier if the same physician performed the procedure again on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure again 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 had 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
- Apply this modifier if the procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician practitioner 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 if a resident performed part of the procedure 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 if the procedure involved anesthesia directed by a physician for multiple concurrent procedures.
16. Modifier QS - Monitored Anesthesia Care Service
- This modifier is used to indicate that monitored anesthesia care was provided during the procedure.
17. Modifier QX - CRNA Service: With Medical Direction by a Physician
- Apply this modifier if a Certified Registered Nurse Anesthetist (CRNA) provided the service under the medical direction of a physician.
18. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Use this modifier if an anesthesiologist provided medical direction for one CRNA.
19. Modifier QZ - CRNA Service: Without Medical Direction by a Physician
- This modifier is used if a CRNA provided the service without the medical direction of a physician.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the services provided.
The CPT code 44372 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 44372.
It is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure compliance with Medicare's reimbursement criteria for this specific code.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 44372. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
