CPT code 45172 is for excision of a rectal tumor through the anal canal, indicating a specific surgical procedure.
CPT code 45172 is used to describe a surgical procedure involving the excision of a rectal tumor through the anal canal. This procedure is typically performed to remove a tumor located in the rectum, allowing for access and removal without the need for a larger abdominal incision. The term "transanal" indicates that the approach is made through the anus, and "full" suggests that the excision is complete, aiming to remove the entire tumor along with a margin of healthy tissue to ensure that no cancerous cells remain.
For CPT code 45172, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure: If the procedure was performed on both sides of the body, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be used to indicate that.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: If the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient, this modifier should be used.
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.
7. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure, this modifier should be appended.
8. Modifier 66 - Surgical Team: Use this modifier if the procedure required a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: If the same physician performed the procedure again within a short period, this modifier should be used.
10. Modifier 77 - Repeat Procedure by Another Physician: If a different physician performed the procedure again within a short period, this modifier should be used.
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 if the patient had to 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: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: If an assistant surgeon was required for the procedure, this modifier should be appended.
14. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the circumstances surrounding the procedure to ensure accurate billing and reimbursement.
Determining if CPT code 45172 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 covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 45172 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or other authorized platforms that provide access to the MPFS. Additionally, MACs, which are regional contractors responsible for processing Medicare claims, may have specific guidelines or local coverage determinations (LCDs) that affect the reimbursement status of CPT code 45172.
In summary, to determine if CPT code 45172 is reimbursed by Medicare, you should:
1. Check the Medicare Physician Fee Schedule (MPFS) for the specific CPT code.
2. Review any relevant local coverage determinations (LCDs) or guidelines provided by your regional Medicare Administrative Contractor (MAC).
By following these steps, you can ascertain whether CPT code 45172 is eligible for reimbursement under Medicare.
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