CPT code 45379 is a medical billing code for a colonoscopy procedure that includes the removal of foreign bodies.
CPT code 45379 is for a colonoscopy procedure that includes the removal of foreign bodies. This code is used when a healthcare provider performs a colonoscopy, which is an examination of the colon using a flexible tube with a camera, and during this procedure, they also remove any foreign objects that may be present in the colon.
For CPT code 45379 (Colonoscopy with foreign body removal), 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 during the colonoscopy.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. 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.
4. 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. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the colonoscopy on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician repeats the colonoscopy on the same day.
7. 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.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the colonoscopy is performed during the postoperative period of another procedure but is unrelated to the original procedure.
9. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 45379 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
For CPT code 45379, you would need to verify its inclusion in the MPFS. If it is listed, then Medicare reimburses this code, subject to the specific terms and conditions outlined by the MPFS. Additionally, your MAC can provide further clarification and guidance on any regional variations or specific documentation requirements that may affect reimbursement for CPT code 45379. Always ensure to stay updated with both the MPFS and MAC guidelines to confirm the current reimbursement status.
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