CPT code 45335 is for a sigmoidoscopy procedure with submucosal injection, used to examine the lower part of the colon.
CPT code 45335 is for a sigmoidoscopy procedure that includes submucosal injection. This means that during the sigmoidoscopy, a healthcare provider examines the sigmoid colon using a flexible tube equipped with a camera. Additionally, they perform an injection into the submucosal layer of the colon, which may be used for therapeutic purposes, such as treating lesions or managing bleeding. This code is typically used for billing and documentation purposes in healthcare settings.
For CPT code 45335 (Sigmoidoscopy with submucosal injection), 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 26 - Professional Component: Indicates that the service provided was the professional component only, such as the interpretation of results.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session by the same provider.
4. Modifier 52 - Reduced Services: Indicates that 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: Indicates 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 subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when a related procedure during the postoperative period requires a return to the operating room.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was 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: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 45335, which involves a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if Medicare reimburses this code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and coverage policies for various CPT codes.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for specific guidance. MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement status of CPT code 45335. They may also offer insights into any additional documentation or criteria required for successful reimbursement.
In summary, while CPT code 45335 can be reimbursed by Medicare, it is crucial to verify the details through the MPFS and consult with the appropriate MAC to ensure compliance with all Medicare requirements.
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