CPT code 45391 is a medical billing code for a colonoscopy procedure using an endoscope for diagnostic purposes.
CPT code 45391 is for a colonoscopy procedure that involves the use of an endoscope to examine the colon and rectum. This code specifically indicates that the colonoscopy is performed with the assistance of an endoscope, which is a flexible tube equipped with a camera and light, allowing for a detailed view of the intestinal lining. This procedure is typically used for diagnostic purposes, such as identifying abnormalities, polyps, or signs of colorectal cancer.
For CPT code 45391, which pertains to a colonoscopy with endoscopic ultrasound, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the physician who performs the interpretation of the ultrasound.
2. Modifier 52 - Reduced Services: Applied when the procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when the procedure is 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.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician on the same day.
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: Indicates an unplanned 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: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Applied when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
10. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used according to the guidelines to ensure accurate billing and reimbursement.
The CPT code 45391 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different guidelines and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information regarding the reimbursement for CPT code 45391.
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