CPT code 45123 is a medical billing code used to describe a partial proctectomy procedure for accurate healthcare billing and documentation.
CPT code 45123 is for a partial proctectomy, which is a surgical procedure involving the removal of a portion of the rectum. This procedure is typically performed to treat conditions such as rectal cancer, inflammatory bowel disease, or other rectal disorders. The goal of a partial proctectomy is to alleviate symptoms, remove diseased tissue, and improve the patient's overall health.
For CPT code 45123 (Partial proctectomy), the following modifiers may be applicable:
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 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than what is typically required for the procedure.
3. Modifier 53 - Discontinued Procedure
- This modifier is used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful when multiple procedures are performed and need to be billed separately.
5. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons are required to perform the procedure together, each acting as a primary surgeon for distinct parts of the surgery.
6. Modifier 66 - Surgical Team
- This modifier is used when the procedure requires a surgical team due to the complexity of the operation.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to repeat the procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician needs to repeat the procedure on the same day.
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
- This modifier is used when the patient needs to 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
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required to help with the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the 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 45123 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. To determine the exact reimbursement rate for CPT code 45123, you would need to consult the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates. Therefore, it is advisable to check with your local MAC to confirm the reimbursement details for CPT code 45123.
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