CPT code 45390 is a medical billing code for a colonoscopy procedure that includes the removal of tissue or polyps during the exam.
CPT code 45390 is a procedure that involves a colonoscopy with resection. This means that during the colonoscopy, a physician not only examines the colon but also removes a portion of tissue or a polyp that may be abnormal or potentially cancerous. This procedure is typically performed to diagnose and treat conditions affecting the colon, ensuring that any problematic areas are addressed during the examination.
For CPT code 45390 (Colonoscopy with resection), 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 other factors that increase the complexity of the procedure.
2. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
3. 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.
4. 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 identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider subsequent to the original procedure.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when a procedure or service is repeated by a different provider subsequent to the original procedure.
7. 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 patient requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 45390 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To verify reimbursement for CPT code 45390, you should:
1. Check the MPFS: Access the latest version of the MPFS to see if CPT code 45390 is listed and to review the associated reimbursement rates. The MPFS will provide detailed information on whether the code is covered and the payment amount.
2. Consult Your MAC: Each MAC may have specific guidelines and policies regarding the reimbursement of certain CPT codes. It is crucial to review any local coverage determinations (LCDs) or national coverage determinations (NCDs) that your MAC has issued concerning CPT code 45390.
By following these steps, you can determine if CPT code 45390 is reimbursed by Medicare and understand any specific requirements or limitations that may apply.
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