CPT code 45113 is a medical billing code used to describe a partial proctectomy procedure, which involves the surgical removal of part of the rectum.
CPT code 45113 is used to describe a surgical procedure known as a partial proctectomy. This procedure involves the surgical removal of a portion of the rectum, typically performed to treat conditions such as rectal cancer, inflammatory bowel disease, or other rectal disorders. The code indicates that the surgery is focused on excising only a part of the rectum rather than the entire organ, which distinguishes it from more extensive surgical interventions.
For CPT code 45113 (Partial proctectomy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 52 - Reduced Services
- Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure
- Used when a procedure is terminated 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 62 - Two Surgeons
- When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team
- Used when a team of surgeons is required to perform the procedure.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Indicates that a procedure or service was 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 or Other Qualified Health Care Professional
- Indicates that a procedure or service was 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 related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Indicates that a minimum assistant surgeon is required for 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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
These modifiers help provide additional information about the circumstances under which the partial proctectomy was performed, ensuring accurate billing and reimbursement.
The CPT code 45113, which refers to a partial proctectomy, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 45113.
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