CPT code 44407 is a medical billing code for a colonoscopy procedure with needle aspiration and biopsy.
CPT code 44407 is for a colonoscopy procedure that includes the aspiration of fluid and the biopsy of tissue. This code is used when a healthcare provider performs a colonoscopy, which is a visual examination of the colon, and during this procedure, they also collect a sample of tissue for further analysis and may remove any abnormal fluid present.
For CPT code 44407 (Colonoscopy with needle aspiration/biopsy), 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. This could be due to complications or additional work involved in the procedure.
2. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically applicable when the procedure involves both a technical and a professional component.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session. This modifier indicates that the procedure is one of several performed on the same day.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
7. 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.
8. 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.
9. 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 patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. 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.
14. 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 44407 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 44407 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect reimbursement. These LCDs provide detailed information on whether a particular service is covered and under what conditions.
In summary, to determine if CPT code 44407 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC's LCDs for your region.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 44407. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
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
