CPT code 45130 is for the surgical excision of rectal prolapse, a procedure to remove the protruding rectal tissue.
CPT code 45130 is the procedure for the excision of rectal prolapse. This code is used when a healthcare provider surgically removes a portion of the rectum that has protruded through the anus, a condition known as rectal prolapse. The procedure aims to alleviate symptoms and restore normal anatomy, improving the patient's quality of life.
For CPT code 45130 (Excision of rectal prolapse), 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 increased complexity or difficulty of the procedure.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. 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.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform a complex procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician on the same day.
11. 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.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help in providing additional information about the performed procedure, ensuring accurate billing and reimbursement.
The CPT code 45130, which involves excision of rectal prolapse, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various medical services covered by Medicare.
Additionally, it is essential to consult with the appropriate Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 45130. Schedule a demo today to see how RevFind can help you identify and recover revenue from individual payers.
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