CPT code 45386 is a medical billing code for a colonoscopy procedure that includes balloon dilation to treat strictures in the colon.
CPT code 45386 is for a colonoscopy procedure that includes the use of balloon dilation. This code is specifically used when a physician performs a colonoscopy to examine the interior of the colon and rectum, and during this procedure, they utilize a balloon to dilate or widen a narrowed area within the colon. This can be necessary for treating strictures or obstructions, allowing for improved passage and function within the gastrointestinal tract.
For CPT code 45386, which pertains to a colonoscopy with balloon dilation, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 26 - Professional Component
- Indicates that only the professional component of the service was provided. This is relevant if the procedure involves both a professional and technical component.
3. Modifier 52 - Reduced Services
- Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Indicates that the same procedure was repeated by another physician on the same day.
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 was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
11. Modifier 99 - Multiple Modifiers
- Indicates that multiple modifiers are applicable to the service or procedure. This is used when two or more modifiers are necessary to describe the service accurately.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper application of these modifiers can help avoid claim denials and ensure compliance with payer requirements.
CPT code 45386 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating 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. Providers should consult their MAC for detailed guidance on billing and reimbursement for this procedure.
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