CPT code 45346 is for a sigmoidoscopy procedure that includes ablation, used to treat conditions in the lower intestine.
CPT code 45346 is for a sigmoidoscopy procedure that includes the use of ablation techniques. This code indicates that a healthcare provider performed a minimally invasive examination of the sigmoid colon, which is the lower part of the large intestine, and utilized ablation to remove or destroy abnormal tissue during the procedure. This is typically done to treat conditions such as polyps or other lesions found in the sigmoid area.
For CPT code 45346 (Sigmoidoscopy with ablation), 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 complications or other factors that necessitate additional time and effort.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same session. This indicates that more than one procedure was carried out, which may affect reimbursement.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full procedure was not necessary or could not be completed.
4. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is 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.
The CPT code 45346, which involves a sigmoidoscopy with ablation, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various medical services covered by Medicare.
Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 45346.
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