CPT code 45349 is for a sigmoidoscopy procedure that includes the resection of tissue for diagnostic or therapeutic purposes.
CPT code 45349 is for a sigmoidoscopy procedure that includes the resection of tissue. This means that during the sigmoidoscopy, a healthcare provider examines the sigmoid colon and may also remove abnormal tissue or polyps for further analysis. This procedure is typically performed to diagnose or treat conditions affecting the lower part of the colon.
For CPT code 45349 (Sigmoidoscopy with resection), 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 51 - Multiple Procedures: Indicates that multiple procedures were performed during the same session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Indicates that a 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: 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: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician subsequent to the original procedure or service.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure or service performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
12. 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.
13. 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.
Determining whether CPT code 45349 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 45349 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect the reimbursement status of CPT code 45349.
Therefore, it is essential to review both the MPFS and any relevant LCDs from your MAC to confirm if CPT code 45349 is eligible for Medicare reimbursement.
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