CPT code 45317 is a medical billing code for a proctosigmoidoscopy procedure used to diagnose and treat bleeding in the rectum or lower colon.
CPT code 45317 is used to describe a proctosigmoidoscopy procedure performed specifically to investigate and manage bleeding in the rectum or lower colon. This procedure involves the insertion of a flexible tube equipped with a camera into the rectum and sigmoid colon to visualize the area, identify the source of bleeding, and potentially treat any abnormalities found.
For CPT code 45317, which pertains to proctosigmoidoscopy with control of bleeding, 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. This could apply if the control of bleeding was particularly complex or time-consuming.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same session. If 45317 is performed along with other procedures, this modifier would indicate that multiple services were provided.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could be relevant if the proctosigmoidoscopy was initiated but not completed due to unforeseen circumstances.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This might be used if 45317 is performed in conjunction with other endoscopic procedures that are not typically reported together.
5. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician. This could be relevant if the patient required another proctosigmoidoscopy with control of bleeding within a short period.
6. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician. This might be necessary if another physician had to perform the procedure due to scheduling or availability issues.
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 needs to return to the operating room for a related procedure during the postoperative period of the initial procedure.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided. This might be relevant if multiple circumstances apply to the procedure.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
CPT code 45317 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. Healthcare providers should consult their local MAC for detailed coverage guidelines and reimbursement rates for CPT 45317.
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