CPT code 45347 is a medical billing code for a sigmoidoscopy procedure with stent placement, used to describe specific healthcare services.
CPT code 45347 is for a sigmoidoscopy procedure that includes the placement of a stent. This procedure involves the use of a flexible tube with a camera to examine the sigmoid colon and rectum, allowing healthcare providers to diagnose and treat conditions within this part of the gastrointestinal tract. The addition of stent placement indicates that during the procedure, a stent is inserted to help keep a narrowed or blocked area open, facilitating better passage of stool or other materials.
For CPT code 45347 (Sigmoidoscopy with placement of stent), 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 unusual circumstances.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of the procedure.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the same procedure was 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: This modifier is used 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 if an unrelated procedure is performed by the same physician during the postoperative period.
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 if an assistant surgeon is required and 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 these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
Determining if CPT code 45347 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your local Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. Each MAC, which administers Medicare claims for specific regions, may have additional guidelines or requirements for reimbursement.
To verify if CPT code 45347 is reimbursed, you should:
1. Consult the MPFS: Access the latest MPFS to see if CPT code 45347 is listed and review the associated reimbursement rate.
2. Check with your MAC: Contact your regional MAC for any specific coverage policies or additional documentation requirements that may apply to CPT code 45347.
By following these steps, you can determine if CPT code 45347 is eligible for reimbursement under Medicare.
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