CPT code 44404 is a medical billing code for a colonoscopy procedure that includes an injection, used for accurate healthcare billing and documentation.
CPT code 44404 is for a colonoscopy procedure that includes the injection of a substance, typically for therapeutic purposes. This code indicates that during the colonoscopy, a healthcare provider administers an injection to treat a specific condition or to enhance the examination of the colon. This may involve the use of medications or contrast agents to improve visualization or to manage issues such as bleeding or polyps.
When billing for CPT code 44404 (Colonoscopy with injection), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. Documentation must support the increased complexity.
2. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service was provided.
3. Modifier 52 - Reduced Services: Use 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: Use this modifier 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: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician 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: Use this modifier if the patient returns 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: Use 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 for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for 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: Use this modifier if a non-physician practitioner assisted in the surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Use this modifier if the service was performed by a resident under the supervision of a teaching physician.
15. Modifier PT - Colorectal Cancer Screening Test; converted to diagnostic test or other procedure: Use this modifier if a planned colorectal cancer screening test was converted to a diagnostic test or other procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
When determining if CPT code 44404 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually. Each MAC may have specific local coverage determinations (LCDs) that can affect reimbursement.
To verify if CPT code 44404 is reimbursed, you should:
1. Check the MPFS: Access the latest MPFS database to see if CPT code 44404 is listed and what the reimbursement rate is.
2. Consult Your MAC: Review any LCDs or other guidance documents from your regional MAC to ensure there are no additional criteria or restrictions for reimbursement.
By following these steps, you can confirm whether CPT code 44404 is reimbursed by Medicare and understand any specific conditions that may apply.
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 44404. Schedule a demo today to see how RevFind can help you identify and address payment discrepancies with individual payers, ensuring you receive the full reimbursement you deserve.
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
