CPT code 45126 is a medical billing code used to describe a pelvic exenteration procedure, which involves the removal of pelvic organs.
CPT code 45126 is a surgical procedure that involves the complete removal of the pelvic organs, including the bladder, rectum, and reproductive organs. This extensive operation is typically performed to treat certain types of cancer or severe pelvic disease, aiming to eliminate the disease and prevent its spread.
For CPT code 45126 (Pelvic exenteration), 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. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the pelvic exenteration was one of several procedures performed.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could apply if the pelvic exenteration was not completed in its entirety.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. This could be relevant if the pelvic exenteration requires the expertise of two surgeons.
6. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure. This may be necessary for complex cases of pelvic exenteration.
7. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure. This indicates that another surgeon assisted in the pelvic exenteration.
8. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers provides additional information about the circumstances under which the pelvic exenteration was performed, ensuring accurate billing and reimbursement.
The CPT code 45126, which pertains to pelvic exenteration, is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm coverage and any regional variations in reimbursement policies. The MAC is responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding the reimbursement of CPT code 45126.
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