CPT code 45499 is a specific code used to describe an unlisted laparoscopic procedure for the rectum in healthcare billing and documentation.
CPT code 45499 is used to describe an unlisted laparoscopic procedure involving the rectum. This code is typically utilized when a specific laparoscopic procedure on the rectum does not have a designated code in the Current Procedural Terminology (CPT) system. It allows healthcare providers to report and bill for unique or experimental laparoscopic techniques performed on the rectum that are not explicitly categorized elsewhere.
For CPT code 45499 (Laparoscope procedure rectum), 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 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated 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 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Used when a complex procedure requires the services of several physicians, often of different specialties, working together.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician 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 patient requires a return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during a 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 a qualified resident surgeon is not available, and an assistant surgeon is required.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
15. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used in teaching settings where residents are involved in the procedure.
16. Modifier QX - CRNA Service: With Medical Direction by a Physician: Indicates that a Certified Registered Nurse Anesthetist (CRNA) provided anesthesia services under the medical direction of a physician.
17. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Used when an anesthesiologist provides medical direction for one CRNA.
18. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Indicates that an anesthesiologist is directing multiple anesthesia procedures concurrently.
19. Modifier QS - Monitored Anesthesia Care Service: Used to indicate that monitored anesthesia care was provided.
20. Modifier G8 - Monitored Anesthesia Care (MAC) for Deep Complex, Complicated, or Markedly Invasive Surgical Procedure: Indicates the complexity of the procedure requiring monitored anesthesia care.
21. Modifier G9 - Monitored Anesthesia Care for Patient Who Has a History of Severe Cardiopulmonary Condition: Used when the patient has a significant cardiopulmonary condition necessitating monitored anesthesia care.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 45499 is not typically reimbursed by Medicare. This code is considered an unlisted procedure code, which means it does not have a set reimbursement rate in the Medicare Physician Fee Schedule (MPFS). When using this code, providers must submit additional documentation to their Medicare Administrative Contractor (MAC) for individual consideration and potential reimbursement on a case-by-case basis.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 45499. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, ensuring you receive the full reimbursement you deserve.
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
