CPT code 44406 is for a colonoscopy procedure that includes ultrasound, used to examine the colon and surrounding tissues.
CPT code 44406 is for a colonoscopy procedure that includes the use of ultrasound technology. This code indicates that during the colonoscopy, the physician performs an examination of the colon while simultaneously utilizing ultrasound to assess the surrounding structures. This combination allows for a more comprehensive evaluation of the colon and adjacent tissues, aiding in the diagnosis and management of various gastrointestinal conditions.
For CPT code 44406 (Colonoscopy with ultrasound), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the ultrasound.
2. Modifier 52 - Reduced Services: Applied when the procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 44406, which is for a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, the reimbursement can vary slightly depending on the region, as Medicare Administrative Contractors (MACs) may have localized adjustments. Therefore, it is advisable to check with the relevant MAC for the most accurate and up-to-date reimbursement information for CPT code 44406.
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