CPT code 44397 is for a colonoscopy procedure that includes the placement of a stent to manage blockages in the colon.
CPT code 44397 is used to describe a colonoscopy procedure that involves the placement of a stent within the colon. This procedure is typically performed to relieve obstructions or strictures in the colon, allowing for improved passage of stool and reducing the risk of complications. The stent helps to keep the affected area open, facilitating better bowel function and overall patient care.
When using CPT code 44397 for Colonoscopy with stent placement, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure 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: 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: 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 is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Indicates that 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: Used when these non-physician practitioners assist in surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings to indicate that a resident was involved in the procedure 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: Indicates that an anesthesiologist is directing one CRNA in the provision of anesthesia services.
17. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used when an anesthesiologist is directing multiple anesthesia procedures concurrently.
18. Modifier QS - Monitored anesthesia care service: Indicates that monitored anesthesia care was provided.
19. Modifier G8 - Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedures: Used for specific anesthesia services.
20. Modifier G9 - Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition: Indicates that the patient has a significant cardiopulmonary condition requiring monitored anesthesia care.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and appropriate reimbursement.
CPT code 44397 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for your region and any applicable local coverage determinations. Providers should consult their MAC for detailed guidance on billing and reimbursement for this code.
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