CPT code 45355 is a specific code used to describe a surgical colonoscopy procedure for billing and documentation in healthcare.
CPT code 45355 is for a surgical colonoscopy, which involves the examination of the entire colon using a flexible tube with a camera, allowing the healthcare provider to diagnose and potentially treat conditions within the colon. This procedure may include the removal of polyps or other tissue samples for further analysis.
For CPT code 45355 (Surgical colonoscopy), 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 26 - Professional Component: Indicates that only the professional component of the service was provided.
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 or Service by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional 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 or other qualified healthcare professional.
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 an unrelated procedure or service was performed by the same physician during the postoperative period.
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 physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
These modifiers help provide additional information about the circumstances under which the surgical colonoscopy was performed, ensuring accurate billing and reimbursement.
CPT code 45355 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for the provider's region and any applicable local coverage determinations. Providers should consult their MAC for specific coverage and payment information related to CPT 45355.
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