CPT code 45384 is for a colonoscopy procedure that includes the removal of a lesion during the examination.
CPT code 45384 is a procedure code that describes a colonoscopy performed with the removal of a lesion. This means that during the colonoscopy, a healthcare provider examines the colon and rectum using a flexible tube with a camera, and if any abnormal growths or lesions are found, they are removed during the same procedure. This code is used for billing and documentation purposes to indicate that both the diagnostic examination and the therapeutic intervention were completed.
For CPT code 45384 (Colonoscopy with lesion removal), 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: Used when only the professional component of the service is being billed.
3. Modifier 33 - Preventive Services: Used to indicate that the service was preventive and not for treatment of an existing condition.
4. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
6. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. 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.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Used when a related procedure is performed during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in surgery.
17. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings.
18. Modifier QX - CRNA service with medical direction by a physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
19. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Used when an anesthesiologist provides medical direction for one CRNA.
20. Modifier QZ - CRNA service without medical direction by a physician: Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 45384 is reimbursed by Medicare, but the reimbursement is subject to the guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the specific coverage and reimbursement policies for CPT code 45384 within their respective jurisdictions. It is essential for healthcare providers to consult the MPFS and their local MAC to understand the exact reimbursement details and any specific requirements that may apply.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 45384. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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