CPT code 45308 is a medical billing code for proctosigmoidoscopy procedures involving the removal of tissue or polyps from the rectum and sigmoid colon.
CPT code 45308 is for a proctosigmoidoscopy procedure that involves the removal of tissue or polyps from the rectum and lower part of the colon. This minimally invasive examination allows healthcare providers to visualize the rectum and sigmoid colon, and the removal aspect indicates that a therapeutic intervention is being performed during the diagnostic procedure.
For CPT code 45308, which pertains to proctosigmoidoscopy with removal, 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 factors such as increased complexity or unusual patient anatomy.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
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. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician repeats the procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician repeats the procedure 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 when the patient requires a 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 the procedure is performed by the same physician during the postoperative period but is unrelated to the original procedure.
9. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and appropriate reimbursement.
Determining whether CPT code 45308 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates.
To verify if CPT code 45308 is reimbursed, you should first check the MPFS for the specific code. Additionally, each MAC may have specific local coverage determinations (LCDs) that can affect reimbursement. Therefore, it is crucial to review both the MPFS and any relevant LCDs from your MAC to confirm if CPT code 45308 is reimbursed by Medicare.
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