CPT code 45380 is a medical billing code for a colonoscopy procedure that includes taking a biopsy for further examination.
CPT code 45380 is for a colonoscopy procedure that includes the performance of a biopsy. This code indicates that a healthcare provider has conducted a thorough examination of the colon using a flexible tube with a camera, and during this examination, they have taken tissue samples for further analysis. This procedure is typically used to diagnose conditions such as colorectal cancer, polyps, or inflammatory bowel disease.
For CPT code 45380, which pertains to a colonoscopy with biopsy, 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. This could be due to complications or additional time and effort.
2. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by a physician or other qualified healthcare professional.
3. Modifier 33 - Preventive Services: Used to indicate that the service was preventive, in accordance with U.S. Preventive Services Task Force (USPSTF) guidelines.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure 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.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Used for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for an unrelated procedure or service by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
15. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings.
16. Modifier QW - CLIA waived test: Used for tests that are waived under the Clinical Laboratory Improvement Amendments (CLIA).
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 45380 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
CPT code 45380 is generally reimbursed by Medicare, but the exact reimbursement amount and any specific coverage criteria can vary based on the MAC's local policies. It is crucial to verify the details with your specific MAC to ensure compliance with any regional variations or additional documentation requirements. Always refer to the latest MPFS and MAC guidelines to confirm the current status and reimbursement details for CPT code 45380.
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