CPT code 45307 is a medical billing code for a proctosigmoidoscopy procedure, used to examine the rectum and lower part of the colon.
CPT code 45307 is for a proctosigmoidoscopy procedure that involves the examination of the rectum and the lower part of the colon using a flexible tube equipped with a camera. This procedure is typically performed to investigate symptoms such as rectal bleeding, abdominal pain, or changes in bowel habits. The "fb" in the description indicates that the procedure is performed with the use of a flexible endoscope.
For CPT code 45307, which pertains to proctosigmoidoscopy with foreign body removal, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. For example, if the foreign body was particularly difficult to remove.
2. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. For instance, if the proctosigmoidoscopy was initiated but not completed due to patient complications.
3. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. 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. For example, if another endoscopic procedure was performed on the same day but in a different anatomical site.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by the same physician or healthcare professional on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure was repeated by a different physician or healthcare professional on the same day.
7. 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.
8. 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 of the initial procedure.
9. Modifier 99 - Multiple Modifiers
- Apply this modifier if multiple modifiers are needed to describe the service provided. This is used when two or more modifiers affect the payment or processing of the claim.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and compliance with payer requirements.
CPT code 45307 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 essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 45307, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management and safeguard your practice's financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
