CPT® Code 45397

CPT Assistant Articles
Additional Code Info
Anatomy/Physiology Online
Dictionary Definitions Illustrations
My Notes
Alerts

Newsletters
Coding Tips
Fees - Facility
Fees - Non-Facility
RVUs - Facility: Show Details
RVUs - Non-Facility: Show Details

Cross-A-Code
NCCI Edits - Facility
NCCI Edits - Non-Facility
Medicare Policies & Guidelines
PQRS

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Code History

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My Notes

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CPT^® Assistant Articles

CPT^® Assistant is the official newsletter on CPT coding, published by the AMA. The CPT Assistant Archives are available to subscribers as an add-on.

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The following CPT^® Assistant Articles refer to this code (45397):

2006

Surgery: Digestive System-- Rectum (April 2006)

Revisions to the Digestive System (April 2006)

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DecisionHealth^® Articles

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The following DecisionHealth^® Articles are linked to this code (45397):

Answer Books

Answer_Book / HCPCS_Codes / 40490 - 49999 (2009)

Answer_Book / HCPCS_Codes / 5 40490 - 49999 (2008)

Coder Pink Sheets

Ask Joan (2008)

CCI bundles more digestive services (2007)

CPT 2006: Review of many significant changes for surgeons in the just-released Manual (2005)

Here's what you need to know about PQRI (2007)

Large share of CCI version 13.2 edits applies to digestive procedures (2007)

Latest CCI contains a few changes ObGyns need to be aware of (2007)

Medicare assigns values to new, revised CPT codes (2005)

More CCI edits for urology from version 13.1 (2007)

UHC updates anesthesia payment policy (2009)

What you need to know about Medicare's P4P program (2007)

Part B News

Controversy likely over new clinical judgment MUEs (2007)

CPT: Get another preview of the code changes coming next year; Laparoscopy, MRI, E/M changes among top changes next year (2007)

E/M, digestive surgery codes top list of new CCI edits (2007)

Latest ‘unbelievable' edits reduced, less controversial (2006)

OIG suggests CMS increase audits for commonly used modifiers -25, -59 (2005)

Second batch of 'unlikely' edits again avoids controversy (2006)

Thousands of new edits: Many tied to billing injections (2006)

Year 2006 conversion factor set at $36.1770 (2005)

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AHA Coding Clinic^® Articles

AHA Coding Clinic^® for HCPCS

No AHA Coding Clinic^® for HCPCS Articles link directly to this code.

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Coding Tips

Subscribers will see the tips about using this code for billing and reimbursement.

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Fees

Calculated for UT (84043)

* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.

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Facility (Hospital, etc.)

Modifier	Medicare Allowed	150%	200%	My Fee
(none)	$2,140.40	$3,210.60	$4,280.81	(your fee)

Modifier	Allowed	Medicare 80%	Patient Pays
(none)	$2,140.40	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

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Non-Facility (Office, etc.)

Modifier	Medicare Allowed	150%	200%	My Fee
(none)	$2,140.40	$3,210.60	$4,280.81	(your fee)

Modifier	Allowed	Medicare 80%	Patient Pays
(none)	$2,140.40	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

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APC Fee Information

Note: APC information, including Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more, is available to Subscribers with the Hospital/Facility product.

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RVUs - Relative Value Units

Calculated for UT (84043)

* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.

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Facility 62.91 (Hospital, etc.)

RVU Components (by modifier)

Modifier	Work	Practice Expense	Malpractice Expense	Total
(none)	36.5	19.78	6.63	62.91

Note: Subscribers with the Hospital/Facility product will see calculated values below.

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Practitioner Work Component: 36.5

Pre-Service	Intra-Service	Post-Service	Total Time*
##	##	##	## min

Modifier	National Unadjusted Work RVU	Work GPCI	Adjusted Work RVU
(none)	##.##	##.##	36.5

Practice Expense: 19.78

Staff	Staff Rate	Pre Time	Intra Time	Post Time	Total Time*
RN/LPN/MTA	.37 / min	## min	## min	## min	## min

Item	Purchase Price	Expected Life	Total Time
table, power	$##.##	## years	## min
light, exam	$##.##	## years	## min

Item	Unit Price	Quantity	Unit	Amount
pack, minimum multi-specialty visit	$##.##	##	pack	$##.##
pack, post-op incision care (suture & staple)	$##.##	##	pack	$##.##
stoma adhesive	$##.##	##	oz	$##.##
stoma pouch and wafer	$##.##	##	item	$##.##

Modifier	National Unadjusted PE RVU	PE GPCI	Adjusted PE RVU
(none)	##.##	##.##	19.78

Malpractice Component: 6.63

Modifier	National Unadjusted MP RVU	MP GPCI	Adjusted MP RVU
(none)	##.##	##.##	6.63

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Non-Facility 62.91 (Office, etc.)

RVU Components (by modifier)

Modifier	Work	Practice Expense	Malpractice Expense	Total
(none)	36.5	19.78	6.63	62.91

Note: Subscribers will see the calculated values below.

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Practitioner Work Component: 36.5

Pre-Service	Intra-Service	Post-Service	Total Time*
##	##	##	## min

Modifier	National Unadjusted Work RVU	Work GPCI	Adjusted Work RVU
(none)	##.##	##.##	36.5

Practice Expense: 19.78

Staff	Staff Rate	Pre Time	Intra Time	Post Time	Total Time*
RN/LPN/MTA	.37 / min	## min	## min	## min	## min

Item	Purchase Price	Expected Life	Total Time
table, power	$##.##	## years	## min
light, exam	$##.##	## years	## min

Item	Unit Price	Quantity	Unit	Amount
pack, minimum multi-specialty visit	$##.##	##	pack	$##.##
pack, post-op incision care (suture & staple)	$##.##	##	pack	$##.##
stoma adhesive	$##.##	##	oz	$##.##
stoma pouch and wafer	$##.##	##	item	$##.##

Modifier	National Unadjusted PE RVU	PE GPCI	Adjusted PE RVU
(none)	##.##	##.##	19.78

Malpractice Component: 6.63

Modifier	National Unadjusted MP RVU	MP GPCI	Adjusted MP RVU
(none)	##.##	##.##	6.63

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Cross-A-Code™ (ICD-9, CPT, HCPCS, Modifiers, ASA CROSSWALK^®)

Code relationships between code sets are available to subscribers.

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NCCI Edits

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Medicare Policies & Guidelines

Subscribers may see Crosswalks here for Local Coverage Determinations (LCDs) or Ambulatory Patient Classifications (APCs) with information on covered diagnosis and procedure codes.

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Physician Quality Reporting System (PQRS)

PQRS is a program where an incentive payment is made to professionals who report data on various measures.
Learn more about PQRS or Read about PQRS at cms.gov.

This code (45397) can be used with the following measures:

#	Measure Title	Reporting Options
20	Perioperative Care: Timing of Prophylactic Parenteral Antibiotic - Ordering Physician	Claim, Registry, Group
21	Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin	Claim, Registry, Group
22	Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (Non-Cardiac Procedures)	Claim, Registry, Group
23	Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)	Claim, Registry, Group

Anatomical Language

Blood Vessels

Cardiac Muscle

Case studies

Circulatory Pathways

Epithelium

General Functions of the Skin

Glands

Innate Immunity

Joints

Large Intestine

Organization of Skeletal Tissue

Other Endocrine Glands and Tissues

Skull

Small Intestine

Vessels of the Trunk

2006

Answer Books

Coder Pink Sheets

Part B News

AHA Coding Clinic^® for HCPCS

Anatomical Language

Blood Vessels

Cardiac Muscle

Case studies

Circulatory Pathways

Epithelium

General Functions of the Skin

Glands

Innate Immunity

Joints

Large Intestine

Organization of Skeletal Tissue

Other Endocrine Glands and Tissues

Skull

Small Intestine

Vessels of the Trunk

2006

Answer Books

Coder Pink Sheets

Part B News

AHA Coding Clinic® for HCPCS

AHA Coding Clinic^® for HCPCS