CPT code 45160 is for the excision of a rectal lesion, detailing the procedure for accurate billing and documentation in healthcare.
CPT code 45160 is for the excision of a rectal lesion. This procedure involves the surgical removal of a lesion located in the rectum, which may be necessary for diagnostic purposes or to treat conditions such as tumors or abnormal growths. The excision can vary in complexity depending on the size and nature of the lesion, and it is typically performed by a colorectal surgeon.
For CPT code 45160, which pertains to the excision of a rectal lesion, 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 50 - Bilateral Procedure
- Applied if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Indicates that the service provided was less than usually required.
5. Modifier 53 - Discontinued Procedure
- Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Indicates 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 procedure.
8. Modifier 66 - Surgical Team
- Applied when a team of surgeons is required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Indicates that a procedure was 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
- Indicates that a procedure performed during the postoperative period was 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
- Indicates that a minimum assistant surgeon was required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 45160 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for your region, medical necessity documentation, and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). It's important for healthcare providers to verify coverage and reimbursement details with their local MAC before performing the procedure.
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