CPT code 45116 is for the partial removal of the rectum, used to classify and bill this specific surgical procedure in healthcare.
CPT code 45116 is for the partial removal of the rectum. This procedure involves surgically excising a portion of the rectal tissue, which may be necessary due to conditions such as cancer, polyps, or other rectal disorders. The code is used to document and bill for the surgical intervention, ensuring that healthcare providers are reimbursed for the services rendered.
For CPT code 45116 (Partial removal of rectum), 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.
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 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 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 highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
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 patient requires a return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the performance of a procedure or service during the postoperative period was 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
- Indicates that a minimum assistant surgeon was 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 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 procedure was performed, ensuring accurate billing and reimbursement.
CPT code 45116 is reimbursed by Medicare. The reimbursement rate for this code is determined by the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage guidelines and payment rates, as these may vary by region.
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