CPT code 48545 is a medical billing code used for pancreatorrhaphy, which refers to the surgical repair of the pancreas.
CPT code 48545 is used to describe a surgical procedure known as pancreatorrhaphy, which involves the repair of the pancreas. This procedure is typically performed to address issues such as pancreatic trauma or defects, ensuring the integrity and functionality of the pancreas after surgical intervention.
For CPT code 48545 (Pancreatorrhaphy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the pancreatorrhaphy was one of several procedures performed.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the pancreatorrhaphy was distinct or independent from other services performed on the same day. This is particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their specific part of the surgery.
5. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the skills of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same physician needs to repeat the pancreatorrhaphy procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when a different physician repeats the pancreatorrhaphy procedure on the same day.
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 needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Applied when the pancreatorrhaphy is performed during the postoperative period of another, unrelated procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the pancreatorrhaphy.
11. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon provides minimal assistance during the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Applied when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the pancreatorrhaphy was performed, ensuring accurate billing and reimbursement.
The CPT code 48545 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates and guidelines for services covered under Medicare Part B. Additionally, reimbursement can vary based on the local policies set by the Medicare Administrative Contractor (MAC) for your region. Therefore, it is advisable to consult the MPFS and your respective MAC to obtain accurate and up-to-date information regarding the reimbursement for CPT code 48545.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 48545. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
