Monday, July 19, 2010

COLONOSCOPY CPT code 45355 and covered diagnosis

COLONOSCOPY Procedures and Related CPT and ICD-9 Procedure Codes


CPT Code CPT Description ICD -9 Procedure
45355 Colonoscopy, rigid or flexible, transabdominal via colotomy, single
or multiple		 4525
4521
4824



45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with
or without collection of specimen(s) by brushing or washing, with
or without colon decompression (separate procedure)		 4685
4523



45379 with removal of foreign body 4523
9805



45380 with biopsy, single or multiple 4525
4824



45382 with control of bleeding, any method 4543



45383 with ablation of tumor(s), polyp(s) or other lesion(s), not
amenable to removal by hot biopsy forceps, bipolar cautery or
snare technique		 4543
4835



45384 with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy
forceps or bipolar cautery		 4543
4832



45385 with removal of tumor(s), polyp(s) or other lesion(s) by snare
technique		 4542
4836
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download