CPT code 45120 is for the surgical removal of the rectum, detailing the procedure for accurate billing and documentation in healthcare.
CPT code 45120 is the code used for the surgical procedure involving the removal of the rectum. This procedure may be indicated for various medical conditions, including rectal cancer or severe inflammatory bowel disease. The code encompasses the complete excision of the rectum, which may involve surrounding tissues and structures, depending on the specific clinical scenario.
For CPT code 45120 (Removal of rectum), 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 51 - Multiple Procedures: Indicates that multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Indicates that the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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.
6. Modifier 62 - Two Surgeons: Indicates that two surgeons worked together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.
8. Modifier 76 - Repeat Procedure by Same Physician: Indicates that the same procedure was repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician: Indicates that the same procedure was repeated by another physician.
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: Used when a patient requires a 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: Indicates that an unrelated procedure was performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 45120 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for this CPT code.
It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with Medicare's reimbursement criteria for CPT code 45120.
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