CPT code 46258 is for the removal of an infected or necrotic group of lymph nodes with a fistula.
CPT code 46258 is used to describe the procedure for the removal of an infected or necrotic group of lymph nodes, specifically in the groin area, that is associated with a fistula. This code indicates that the procedure involves excising the lymphatic tissue to address complications arising from an infection or abnormal connection (fistula) in that region.
Certainly! Here are the modifiers that could be used with CPT code 46258, along with the reasons for each:
1. Modifier 22 (Increased Procedural Services)
- Used when the work required to provide a service is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 50 (Bilateral Procedure)
- Used when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures)
- Used when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 (Reduced Services)
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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. This is often used to prevent bundling of services that are normally considered part of a single procedure.
6. Modifier 62 (Two Surgeons)
- Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 (Surgical Team)
- Used when a team of surgeons is required to perform a complex procedure.
8. Modifier 76 (Repeat Procedure by Same Physician)
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 (Repeat Procedure by Another Physician)
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
10. 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 patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 (Assistant Surgeon)
- Used when an assistant surgeon is required during the procedure.
13. Modifier 81 (Minimum Assistant Surgeon)
- Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Used when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help in providing additional information about the performed procedure, ensuring accurate billing and reimbursement.
The CPT code 46258 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC may have specific guidelines and coverage determinations that could affect whether CPT code 46258 is reimbursed.
Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 46258.
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