CPT code 91113 is a medical code used for gastrointestinal tract imaging involving intraluminal colon inspection and reporting.
CPT code 91113 is used to describe a gastrointestinal tract imaging procedure that involves intraluminal colon imaging and interpretation. This code specifically refers to the use of advanced imaging techniques to visualize the interior of the colon, typically for diagnostic purposes. It may be utilized in cases where there is a need to assess conditions affecting the colon, such as inflammatory bowel disease or other gastrointestinal disorders.
For CPT code 91113, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the imaging.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the use of the equipment and the technician's time.
3. Modifier 52 - Reduced Services: Used when the service provided is less extensive than described in the CPT code.
4. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the service provided and ensure accurate billing and reimbursement.
Determining whether CPT code 91113 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To ascertain if CPT code 91113 is reimbursed, you would first check the MPFS database. If the code is listed, it indicates that Medicare recognizes and potentially reimburses the service. However, the final determination often depends on the specific policies and guidelines of your regional MAC, which may have additional criteria or documentation requirements for reimbursement.
Therefore, to confirm if CPT code 91113 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any specific coverage policies or additional requirements.
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