CPT code 45305 is a medical billing code for a proctosigmoidoscopy procedure with biopsy, used to document and bill for this specific service.
CPT code 45305 is for a proctosigmoidoscopy procedure that includes a biopsy. This means that during the examination of the rectum and lower part of the colon, the healthcare provider not only inspects the area but also takes a tissue sample for further analysis. This procedure is typically performed to diagnose conditions such as inflammation, polyps, or cancer in the lower gastrointestinal tract.
For CPT code 45305, which pertains to proctosigmoidoscopy with biopsy, 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 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, such as the interpretation of the biopsy results.
3. Modifier 50 - Bilateral Procedure
- If the procedure was performed bilaterally, this modifier should be appended to indicate that the service was provided on both sides.
4. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session. This helps in identifying that more than one procedure was conducted.
5. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure
- If the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier should be used.
7. 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.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by a different physician on the same day.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 45305, which is listed as Proctosigmoidoscopy with biopsy, is reimbursed by Medicare, but the reimbursement specifics can vary.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 45305.
However, the actual reimbursement amount can differ based on the geographic location and other factors determined by the Medicare Administrative Contractor (MAC) for your region.
It is essential to consult the MPFS and your local MAC to get the most accurate and up-to-date reimbursement information for CPT code 45305.
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