CPT code 45190 is for the destruction of a rectal tumor, detailing the specific procedure for billing and documentation in healthcare.
CPT code 45190 is used to describe the procedure for the destruction of a rectal tumor. This code specifically refers to the techniques employed to eliminate or reduce the size of a tumor located in the rectum, which may involve methods such as cauterization, cryotherapy, or other ablative techniques. This procedure is typically performed to manage rectal tumors that may be benign or malignant, aiming to alleviate symptoms or prevent further complications.
For CPT code 45190 (Destruction rectal tumor), 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.
2. Modifier 50 - Bilateral Procedure: Used 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: 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 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 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
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 related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is 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: Used when these professionals assist in surgery.
15. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings.
16. Modifier QX - CRNA service with medical direction by a physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
17. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Used when an anesthesiologist provides medical direction for one CRNA.
18. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used when an anesthesiologist provides medical direction for multiple anesthesia procedures.
19. Modifier QS - Monitored anesthesia care service: Used to indicate monitored anesthesia care.
20. Modifier G8 - Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure: Used for specific anesthesia services.
21. Modifier G9 - Monitored anesthesia care for patient who has history of severe cardiopulmonary condition: Used for patients with severe cardiopulmonary conditions.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 45190 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements related to CPT 45190.
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