CPT code 45389 is a medical billing code for a colonoscopy procedure that includes the placement of a stent.
CPT code 45389 is for a colonoscopy procedure that includes the placement of a stent. This code indicates that during the colonoscopy, a healthcare provider not only examines the colon but also performs the additional task of inserting a stent to help keep a section of the colon open, which may be necessary for patients with certain conditions such as strictures or obstructions.
For CPT code 45389 (Colonoscopy with stent placement), 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 other factors that necessitate additional time and effort.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically applicable when the physician's interpretation is separate from the technical component.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. 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.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure for the same patient on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same patient 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: This is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Use this modifier when a resident performs the service under the supervision of a teaching physician.
15. Modifier QX - CRNA service with medical direction by a physician: This modifier is used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
16. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Use this modifier when an anesthesiologist provides medical direction for one CRNA.
17. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: This modifier is used when an anesthesiologist provides medical direction for multiple anesthesia procedures.
18. Modifier QS - Monitored anesthesia care service: Use this modifier to indicate that monitored anesthesia care was provided.
19. Modifier G8 - Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedures: This modifier is used for monitored anesthesia care in complex or invasive procedures.
20. Modifier G9 - Monitored anesthesia care for patient who has history of severe cardiopulmonary condition: Use this modifier when monitored anesthesia care is provided to a patient with a severe cardiopulmonary condition.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When considering whether the CPT code 45389 is reimbursed by Medicare, it is essential to refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates.
For CPT code 45389, reimbursement eligibility can be confirmed by checking the MPFS. Additionally, it is important to consult the local Medicare Administrative Contractor (MAC) for specific coverage policies and any potential regional variations. MACs are responsible for processing Medicare claims and can provide detailed information on whether CPT code 45389 is reimbursed in your specific jurisdiction.
In summary, to determine if CPT code 45389 is reimbursed by Medicare, you should review the MPFS and consult your local MAC for precise and up-to-date information.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 45389. Don't let underpayments slip through the cracks—schedule a demo today and 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
