CPT code 44373 is a medical billing code used for small bowel endoscopy procedures, helping healthcare providers document and bill for services accurately.
CPT code 44373 is used to describe a small bowel endoscopy procedure. This code specifically refers to the examination of the small intestine using an endoscope, which is a flexible tube equipped with a camera and light. The procedure allows healthcare providers to visualize the interior of the small bowel, diagnose conditions, and potentially perform therapeutic interventions, such as biopsies or the removal of polyps.
For CPT code 44373 (Small bowel endoscopy), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 26 (Professional Component): Used when only the professional component of the service is being billed, typically applicable when the procedure involves both a technical and a professional component.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 (Discontinued Procedure): Used 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): 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): Used 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): 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): 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): Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used 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): Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
14. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician): Used when a resident performs the service under the supervision of a teaching physician.
15. Modifier QX (CRNA Service: with Medical Direction by a Physician): 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): Used when an anesthesiologist provides medical direction for one CRNA.
17. Modifier QZ (CRNA Service: without Medical Direction by a Physician): Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 44373 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.
To verify if CPT code 44373 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific local coverage determinations (LCDs) that could affect reimbursement for this code.
In summary, to determine if CPT code 44373 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any specific coverage guidelines or restrictions.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 44373. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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
