CPT code 45383 is for the removal of a lesion during a colonoscopy procedure, helping to document and bill for this specific service.
CPT code 45383 is for the removal of a lesion during a colonoscopy procedure. This code specifically indicates that the physician has performed a colonoscopy to identify and excise a growth or abnormal tissue from the colon. The procedure may involve techniques such as snare polypectomy or endoscopic mucosal resection, depending on the size and type of the lesion being removed.
For CPT code 45383 (Lesion removal colonoscopy), 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 the size or number of lesions removed, or the complexity of the patient's condition.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same session. This is common in cases where more than one lesion is removed or additional procedures are conducted during the colonoscopy.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. For example, if the lesion removal was attempted but not fully completed.
4. Modifier 53 - Discontinued Procedure: This modifier is used 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: Apply this modifier to indicate that the lesion removal was a distinct procedure from other services performed on the same day. This is particularly relevant if multiple lesions were removed from different locations within the colon.
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. This could occur if additional lesions were found and removed during a follow-up colonoscopy on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the procedure was repeated by a different physician on the same day. This might be necessary if a specialist was called in to assist with a particularly complex lesion removal.
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: Use this modifier if the patient had to return for an additional lesion removal related to the initial procedure within the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if a new, unrelated lesion removal was performed during the postoperative period of the initial procedure.
10. Modifier 99 - Multiple Modifiers: Use this modifier if more than four modifiers are necessary to describe the procedure accurately. This ensures that all relevant modifiers are considered in the billing process.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the lesion removal colonoscopy procedure.
CPT code 45383 is reimbursed by Medicare. This 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 your region and any applicable local coverage determinations. It's important for healthcare providers to verify coverage and reimbursement rates with their local MAC to ensure accurate billing and payment for this procedure.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving full reimbursement for procedures like CPT code 45383. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
