CPT code 45339 is for a sigmoidoscopy procedure that includes the ablation of a tumor in the lower intestine.
CPT code 45339 is for a sigmoidoscopy procedure that includes the ablation of a tumor. This means that during the sigmoidoscopy, a healthcare provider examines the sigmoid colon and rectum using a flexible tube with a light and camera, and also performs a treatment to destroy or remove a tumor found in that area. This procedure is typically done to diagnose or treat conditions affecting the lower gastrointestinal tract.
For CPT code 45339 (Sigmoidoscopy with ablation of tumor), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This modifier indicates that the procedure was not completed in its entirety.
3. Modifier 53 (Discontinued Procedure): Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This modifier is often used to identify procedures that are not normally reported together but are appropriate under the circumstances.
5. Modifier 76 (Repeat Procedure by Same Physician): Used to indicate that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 (Repeat Procedure by Another Physician): Used to indicate that a procedure or service was repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): Used when a related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
9. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
11. 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.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): 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. Proper documentation is essential to support the use of any modifier.
The CPT code 45339, which involves a specific medical procedure, is subject to reimbursement by Medicare. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 45339.
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