CPT code 44391 is a medical billing code for a colonoscopy procedure performed to investigate and treat gastrointestinal bleeding.
CPT code 44391 is used to describe a colonoscopy procedure specifically performed to investigate and manage gastrointestinal bleeding. This code indicates that the physician is conducting a thorough examination of the colon to identify the source of bleeding, which may involve taking biopsies or performing therapeutic interventions as necessary.
For CPT code 44391, 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.
2. Modifier 26 - Professional Component: Indicates that only the professional component of the service was provided.
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: Indicates that a 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: 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: 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 involved in the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is involved in the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 44391 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their corresponding reimbursement rates. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in your area.
For CPT code 44391, you would first check the MPFS to see if it is listed and what the reimbursement rate is. Additionally, you should review any relevant LCDs from your MAC to ensure there are no specific restrictions or additional documentation requirements for this code. If CPT code 44391 is listed in the MPFS and there are no prohibitive LCDs from your MAC, then it is likely reimbursed by Medicare. Always ensure to stay updated with both the MPFS and MAC guidelines, as policies and coverage can change.
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