CPT code 46255 is used for the removal of an internal or external hemorrhoid in one group, helping to standardize billing and documentation.
CPT code 46255 is used to describe the procedure for the removal of an internal or external hemorrhoid from one group. This code specifically indicates that the healthcare provider is performing a surgical intervention to excise hemorrhoids, which are swollen veins in the rectal area that can cause discomfort and other symptoms. The code is applicable when addressing a single group of hemorrhoids, allowing for accurate billing and documentation of the procedure performed.
When using CPT code 46255, which pertains to the removal of internal and external hemorrhoids for one group, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: If the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier should be applied.
6. 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.
7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be used.
8. Modifier 66 - Surgical Team: If the procedure requires a surgical team, this modifier should be appended.
9. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure.
10. Modifier 77 - Repeat Procedure by Another Physician: If another physician needs to repeat the procedure, this modifier should be used.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required, this modifier should be used.
14. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when a qualified resident surgeon is not available, and an assistant surgeon is required.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these professionals assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 46255 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 46255, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
