CPT code 44380 is for small bowel endoscopy, a procedure to examine the small intestine for diagnostic purposes.
CPT code 44380 is for a small bowel endoscopy performed with or without the use of a balloon. This procedure involves the examination of the small intestine using an endoscope, which is a flexible tube equipped with a camera and light. It allows healthcare providers to visualize the interior of the small bowel, diagnose conditions, and potentially perform therapeutic interventions.
For CPT code 44380, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 26 - Professional Component: Indicates that the service provided was the professional component only, such as the interpretation of results.
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 started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Indicates 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: Indicates an unplanned 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: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Indicates that a physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used when a resident performs part of the service under the supervision of a teaching physician.
15. Modifier QX - CRNA Service: With Medical Direction by a Physician: Indicates that a Certified Registered Nurse Anesthetist (CRNA) provided the service 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: Indicates that a CRNA provided the service 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.
The CPT code 44380 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 advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may apply to the reimbursement of CPT code 44380. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies.
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