CPT code 46260 is for the removal of two or more ingrown or infected hemorroids during a surgical procedure.
CPT code 46260 is used to describe the procedure for the removal of two or more external hemorrhoids. This code indicates that the healthcare provider has performed a surgical intervention to excise or remove these hemorrhoidal tissue masses, which can help alleviate symptoms such as pain, bleeding, or discomfort associated with hemorrhoids.
For CPT code 46260, the following modifiers may be applicable:
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 complications or other factors that increase the complexity of the procedure.
2. Modifier 50 (Bilateral Procedure): Applied 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 modifier indicates that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. Modifier 66 (Surgical Team): Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
7. Modifier 76 (Repeat Procedure by Same Physician): Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure.
8. Modifier 77 (Repeat Procedure by Another Physician): Indicates that a procedure or service was repeated by another physician subsequent to the original procedure.
9. 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 related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): Used when an assistant surgeon provides minimal assistance during the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 46260 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered under Medicare Part B, including the CPT code 46260. However, the final determination of reimbursement can also depend on the policies of the Medicare Administrative Contractor (MAC) that serves your geographic region. Each MAC may have additional local coverage determinations (LCDs) that could affect whether and how the CPT code 46260 is reimbursed. Therefore, it is essential to consult both the MPFS and your specific MAC's guidelines to ensure compliance and proper reimbursement.
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