Mastering the complexities of colon resections is a daily reality for general surgeons. CPT code 44140, a core procedure, requires accurate coding, which is as critical as the surgical procedure.
This guide cuts through the noise, offering clear, practical insights into the billing and reimbursement landscape surrounding partial colectomies. We will discuss the key factors that impact your claims, from documentation essentials to navigating payer policies. Think of this as your go-to resource for streamlining your coding process, ensuring you are accurately reimbursed for the services you render.
Let’s dive into the specifics and make coding one less thing to worry about.
CPT Code 44140 – Description
The CPT code 44140 is from the ‘Excision Procedures on the Intestines (Except Rectum)’ code range, maintained by the American Medical Association (AMA). It covers the surgical removal of the colon portion and reconnecting the cut ends of the colon to restore continuity.
Scenarios Where CPT Code 44140 is Applicable
The following are some practical scenarios where the CPT code 44140 applies:
Diverticulitis with Stricture
Picture this: A seventy-year-old male patient visits the clinic with recurrent episodes of severe diverticulitis. The stricture (narrowing) in the sigmoid colon has complicated the condition.
Initially, the physician attempts to treat the stricture with antibiotics and dietary modifications, but to no avail.
Therefore, the surgeon performs a partial colectomy (CPT code 44140) to remove the diseased portion of the sigmoid colon containing the stricture. Following this, the surgeon anastomoses (reconnects) the healthy colon segments.
Localized Colon Cancer
Consider this: A sixty-five-year-old female patient’s screening colonoscopy reveals a localized, non-obstructing tumor in the descending colon. The physician orders a biopsy, which confirms adenocarcinoma.
Consequently, the surgeon performs a partial colectomy (CPT code 44140). During the procedure, the surgeon removes the segment of the descending colon containing the tumor and regional lymph nodes. Subsequently, the surgeon anastomoses the remaining healthy colon segments.
Volvulus of the Sigmoid Colon
Imagine this: A sixty-year-old male patient visits the physician with a complaint of severe abdominal distension, pain, and obstipation. Therefore, the physician orders a CT scan. The report reveals a sigmoid volvulus (twisting of the sigmoid colon), causing a closed-loop obstruction.
Initially, the physician attempts to treat the condition with endoscopic decompression, but in vain. As a result, the surgeon performs a partial colectomy (CPT code 44140) to remove the gangrenous portion of the sigmoid colon. The physician then anastomoses the remaining colon.
Applicable Modifiers for CPT Code 44140
Here is the list of all applicable modifiers for the partial colectomy procedure:
Modifier 22
Append modifier 22 to the CPT code 44140 when the partial colectomy takes significantly more effort, time, and resources than usual.
Modifier 51
Does the surgeon perform multiple procedures during the same surgical session? If yes, apply modifier 51 to indicate this to the payer.
Modifier 52
Apply modifier 52 to the CPT code 44140 when the physician elects to reduce the scope of or discontinue the partial colectomy.
Modifier 53
Modifier 53 indicates that the surgeon starts the partial colectomy but discontinues it due to unforeseen circumstances threatening the patient’s well-being.
Modifier 59
Append modifier 59 to identify that the partial colectomy is a distinct service, separately reimbursable from other procedures. It is integral in scenarios where multiple procedures are performed on the same day to avoid payment cuts due to bundling errors.
Modifier 62
What happens when two surgeons work together as primary surgeons performing distinct parts of the partial colectomy? Both surgeons should apply modifier 62 to the CPT code 44140.
Modifier 66
Each patient is different, and depending upon the circumstances, care is individualized. Therefore, if the partial colectomy is so complex that it requires a surgical team to perform it successfully, append modifier 66.
Modifier 78
You encounter scenarios where the patient returns to the operating room and is treated by the same physician for a related procedure during the post-operative period of partial colectomy. If this happens, modifier 78 applies.
Modifier 79
Consider the same situation where the patient returns to the operating room. However, this time, the physician performs an unrelated procedure during the post-operative period of the partial colectomy. Here, modifier 79 applies.
Modifier 80
Did the primary surgeon require the services of an assistant surgeon during the partial colectomy? If yes, the assistant surgeon will apply modifier 80 to the CPT code 44140.
Modifier 81
What happens when another physician provides minimal assistance during the procedure? That physician should apply modifier 81 to the CPT 44140 to bill for the services.
Modifier 82
Apply modifier 82 to the CPT code 44140 when an assistant surgeon performs the partial colectomy because a resident surgeon was unavailable.
Modifier AS
Use the modifier AS when a Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), or Physician Assistant (PA) assists during a partial colectomy.
CPT Code 44140 – Billing & Reimbursement Guidelines
Discussed below are the billing and reimbursement requirements related to the partial colectomy procedure:
Demonstrate Medical Necessity
Reimbursement against the CPT code 44140 hinges on establishing medical necessity. Therefore, your documentation must include the patient’s medical history, symptoms, diagnosis, and the rationale for performing the partial colectomy.
Some typical diagnoses that support the medical necessity of performing this procedure include colon cancer, ischemic colitis with necrosis, diverticulitis with complications, and sigmoid volvulus.
Provide Adequate Documentation
Comprehensive documentation is key to getting timely reimbursement for the partial colectomy. Some of the things you should include to reduce the likelihood of denial or payment delay are listed below:
- Details related to patient symptoms.
- Pre-operative diagnosis notes.
- Imaging studies and their results.
- Pathology reports, confirming the diagnosis.
- Operative report, including the resection extent and anastomosis type.
- Post-operative care and any complications.
Ensure Appropriate Modifier Usage
Regardless of the insurance payer (Medicare, Medicaid, or other commercial payer), all emphasize coding specificity. The use of appropriate modifiers is key to achieving it.
Several modifiers may apply when reporting the partial colectomy based on the situation. These include modifiers 22, 51, 52, 53, 59, 62, 66, 78, 79, 80, 81, 82, and AS.
Refer to the ‘Applicable Modifiers for CPT Code 44140’ section for more details.
Review Payer-Specific Policies
Each payer has varying reimbursement and billing guidelines. Therefore, we recommend reviewing their specific policies to ensure accurate claim submission and speedy reimbursement.
Besides, the Medicare Administrative Contractors (MACs) establish regional policies. Review the relevant MACs’ guides to understand the state-specific guidelines.
Additionally, note that some procedures require prior authorization. Thus, you should make it a part of your billing workflow to acquire authorization before rendering services. It helps avoid unfavorable circumstances, such as claim denials and payment delays.
Summary
Phew! So many details to follow through! It is time to wrap up the guide. However, before we conclude let’s quickly revisit everything we learned. We explained that the CPT code 44140 covers the surgical removal of the colon portion and reconnecting the cut ends of the colon to restore continuity. We also shared some scenarios where this CPT code applies.
We provided a comprehensive list of applicable modifiers 22, 51, 52, 53, 59, 62, 66, 78, 79, 80, 81, 82, and AS – and discussed the billing and reimbursement guidelines for partial colectomy.
Hopefully, this blog will serve as your go-to resource when it comes to billing CPT code 44140. Do you want professional help? Outsource general surgery billing and coding services to MediBillMD.
