CPT code 45119 is for the surgical removal of the rectum along with the creation of a reservoir.
CPT code 45119 is used to describe a surgical procedure involving the removal of the rectum along with the creation of a reservoir. This procedure is typically performed in cases where there is a need to treat conditions affecting the rectum, such as cancer or severe inflammatory diseases. The creation of a reservoir allows for the storage of waste, which can help maintain some level of bowel function post-surgery.
When using CPT code 45119 for the removal of the rectum with a reservoir, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that more than one distinct procedure was carried out.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full extent of the procedure was not necessary.
4. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier 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.
6. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
7. Modifier 66 - Surgical Team
- Use this modifier if the procedure required the services of a surgical team due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the procedure again within a short period of time.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure again within a short period of time.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and documentation.
When determining if CPT code 45119 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various healthcare services, and it is updated annually.
To verify reimbursement for CPT code 45119, healthcare providers should review the MPFS to see if the code is listed and if it has an assigned reimbursement rate. Additionally, MACs, which are private health care insurers that have jurisdiction in specific regions, may have specific policies or guidelines that affect reimbursement. Providers should check with their local MAC to ensure there are no additional requirements or restrictions for CPT code 45119.
In summary, to determine if CPT code 45119 is reimbursed by Medicare, healthcare providers need to review the MPFS and consult their regional MAC for any specific guidelines or policies.
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