CPT code 44405 is a medical billing code for a colonoscopy procedure that includes dilation of the colon.
CPT code 44405 is a procedure that involves performing a colonoscopy while also dilating a narrowed section of the colon. This code is used when a healthcare provider examines the colon for abnormalities and simultaneously expands any constricted areas to improve passage and function.
For CPT code 44405 (Colonoscopy with dilation), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed, typically applicable when the procedure involves both a professional and technical component.
3. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
4. Modifier 53 (Discontinued Procedure): This modifier is 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): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is 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): This modifier is 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): This modifier is 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): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is 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): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
14. Modifier GC (Service performed in part by a resident under the direction of a teaching physician): This modifier is 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): This modifier is 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): This modifier is used when an anesthesiologist provides medical direction for one CRNA.
17. Modifier QZ (CRNA service without medical direction by a physician): This modifier is 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.
The CPT code 44405 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 corresponding reimbursement rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your geographic area to confirm the specific reimbursement policies and rates for CPT code 44405.
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