CPT code 45392 is a medical billing code for a colonoscopy procedure with endoscopic fine needle biopsy.
CPT code 45392 is for a colonoscopy procedure that includes endoscopic fine needle biopsy (FNB). This code indicates that during the colonoscopy, the healthcare provider performed a biopsy using a fine needle to obtain tissue samples from the colon for diagnostic purposes. This procedure is typically used to investigate abnormalities found during the colonoscopy, such as polyps or suspicious lesions.
For CPT code 45392 (Colonoscopy with endoscopic fine needle biopsy), 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: Indicates that the service provided was the professional component only, such as the interpretation of results.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session by the same provider.
4. Modifier 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
13. 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.
14. Modifier 99 - Multiple Modifiers: Indicates that multiple modifiers are applicable to the service or procedure.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 45392, which involves a specific procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they provide specific guidelines and updates on coverage and reimbursement policies. The MACs play a crucial role in processing Medicare claims and ensuring compliance with Medicare regulations.
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