CPT code 45112 is a medical billing code used for the removal of the rectum, helping healthcare providers accurately document and bill for procedures.
CPT code 45112 is for the surgical procedure involving the removal of the rectum. This code is used to document and bill for the specific operation where the rectum is excised, typically due to conditions such as cancer, severe inflammatory diseases, or other significant rectal disorders. It is important for healthcare providers to use this code accurately to ensure proper reimbursement and to maintain clear medical records.
For CPT code 45112, which pertains to the removal of the rectum, 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 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
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 started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 62 (Two Surgeons): This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
6. Modifier 66 (Surgical Team): This modifier is used when a team of surgeons is required to perform a complex procedure. Documentation should support the necessity of a team approach.
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): This modifier is 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): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
11. 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.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is crucial to justify the use of any modifier.
CPT code 45112 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 geographic location and the specific Medicare Administrative Contractor (MAC) processing the claim. Providers should consult their local MAC for specific coverage and payment guidelines related to CPT 45112.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 45112, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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