CPT code 45170 is for the excision of a rectal lesion, detailing the procedure for billing and documentation in healthcare.
CPT code 45170 is for the excision of a rectal lesion. This procedure involves the surgical removal of a lesion located in the rectal area, which may include tumors, polyps, or other abnormal growths. The excision is performed to diagnose or treat conditions affecting the rectum, ensuring that any potentially harmful tissue is removed for further examination or to alleviate symptoms.
For CPT code 45170, "Excision of rectal lesion," 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 factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed bilaterally, this modifier should be appended to indicate that the service was performed on both sides of the body.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
4. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
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): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
7. Modifier 62 (Two Surgeons): If two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, this modifier should be used.
8. Modifier 66 (Surgical Team): Used when a highly complex procedure is carried out by a surgical team, indicating that multiple providers were involved in the surgery.
9. Modifier 76 (Repeat Procedure by Same Physician): If the same physician performs a procedure or service more than once on the same day, this modifier should be used.
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): This modifier is 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): Indicates that an assistant surgeon was required for the procedure.
14. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.
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): Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 45170 is reimbursed by Medicare. The 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) in your region and any applicable local coverage determinations (LCDs). It's important for healthcare providers to verify coverage and reimbursement with their local MAC before performing the procedure.
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