CPT code 48547 is a medical billing code used to describe a specific surgical procedure for duodenal exclusion.
CPT code 48547 is a procedure that involves duodenal exclusion, which is a surgical technique used to bypass or exclude the duodenum from the digestive process. This procedure is often performed to treat conditions such as obesity or certain gastrointestinal disorders by altering the way food passes through the digestive system, thereby reducing nutrient absorption and promoting weight loss.
For CPT code 48547 (Duodenal exclusion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier 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 procedure.
2. Modifier 51 - Multiple Procedures
- This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
3. Modifier 52 - Reduced Services
- Apply this modifier when the procedure is partially reduced or eliminated at the physician's discretion. This could occur if the full procedure was not necessary or could not be completed.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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 often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team
- This modifier is used when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Use this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon provides minimal assistance to the primary surgeon.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers provides additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 48547 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, reimbursement for CPT code 48547 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region. It is advisable to consult the latest MPFS and your regional MAC guidelines to ensure accurate and up-to-date information regarding reimbursement for this specific CPT code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 48547. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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