CPT code 45340 is a medical billing code for a sigmoidoscopy with balloon dilation, used to describe a specific procedure in healthcare.
CPT code 45340 is for a sigmoidoscopy procedure that includes the use of a balloon dilation technique. This code indicates that during the sigmoidoscopy, a flexible tube is inserted into the rectum and sigmoid colon to examine the area, and if necessary, a balloon is used to widen any narrowed sections of the colon. This procedure is typically performed to treat conditions such as strictures or obstructions in the sigmoid colon.
For CPT code 45340, which pertains to a specific endoscopic procedure, 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. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 26 - Professional Component: Indicates that only the professional component of the service was provided, typically used when the procedure involves both a technical and a professional component.
3. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Indicates that the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same procedure is repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician subsequent to the original procedure.
9. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
12. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper application of these modifiers can help in avoiding claim denials and ensuring that the healthcare provider is adequately compensated for the services rendered.
The CPT code 45340 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different local coverage determinations (LCDs) and payment policies. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement details for CPT code 45340.
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