CPT code 45136 is used to describe the surgical procedure of excising an ileoanal reservoir, often performed for bowel conditions.
CPT code 45136 is used to describe the surgical procedure of excising an ileoanal reservoir. This procedure typically involves the removal of a surgically created pouch that is formed from the ileum (the last part of the small intestine) and is connected to the anal canal. It is often performed in patients who have undergone a colectomy due to conditions such as ulcerative colitis or familial adenomatous polyposis, allowing for the restoration of bowel function and the ability to have bowel movements through the anus.
For CPT code 45136 (Excise ileoanal reservoir), 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 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. 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.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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: Used when a patient requires a 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: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
13. 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.
14. 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.
Determining if CPT code 45136 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their corresponding reimbursement rates.
To ascertain whether CPT code 45136 is reimbursed, you would need to check the MPFS for the current year. Additionally, MACs, which are regional organizations contracted by Medicare to process claims and provide guidance, may have specific local coverage determinations (LCDs) that affect reimbursement. These LCDs can vary by region and may include additional criteria that must be met for the procedure to be covered.
Therefore, to confirm if CPT code 45136 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific coverage policies or requirements.
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