CPT code 45402 is for a laparoscopic proctopexy with sigmoid resection, a surgical procedure to treat rectal prolapse.
CPT code 45402 is for a laparoscopic proctopexy with sigmoid resection. This procedure involves the surgical fixation of the rectum to the pelvic wall using minimally invasive techniques, along with the removal of a portion of the sigmoid colon. It is typically performed to treat conditions such as rectal prolapse, where the rectum protrudes outside the anus, and may involve addressing associated issues in the sigmoid colon.
For CPT code 45402, which pertains to laparoscopic proctopexy with sigmoid resection, 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 increased the complexity of the surgery.
2. Modifier 51 (Multiple Procedures)
- Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that more than one procedure was carried out, which may affect reimbursement.
3. 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. It is particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 (Two Surgeons)
- Use this modifier if two surgeons were required to perform the procedure together due to its complexity. Each surgeon should report their distinct operative work.
5. Modifier 66 (Surgical Team)
- This modifier is applicable if the procedure required a surgical team due to its complexity. It indicates that multiple professionals were involved in the surgery.
6. Modifier 76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician had to repeat the procedure on the same day. This could be due to complications or other clinical reasons.
7. Modifier 77 (Repeat Procedure by Another Physician)
- Use this modifier if a different physician had to repeat the procedure on the same day. This also could be due to complications or other clinical reasons.
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 modifier is used if the patient had 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)
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon)
- Use this modifier if an assistant surgeon was necessary for the procedure. This indicates that another surgeon assisted the primary surgeon.
11. Modifier 81 (Minimum Assistant Surgeon)
- This modifier is used if a minimum assistant surgeon was required for the procedure, indicating limited but necessary assistance.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Apply this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers provides additional information that can affect billing and reimbursement, ensuring that the complexity and specifics of the procedure are accurately captured.
The CPT code 45402, which refers to a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare, including whether a particular CPT code is reimbursable.
Additionally, it is important to check with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage policies, including any local coverage determinations (LCDs) that may affect reimbursement for CPT code 45402. By consulting both the MPFS and your MAC, you can ascertain whether Medicare will reimburse for this specific procedure.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 45402. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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