CPT code 46607 is for diagnostic anoscopy and biopsy procedures, used to examine and collect tissue from the anal canal.
CPT code 46607 is for a diagnostic anoscopy procedure that includes a biopsy. This code is used when a healthcare provider performs an examination of the anal canal and lower rectum using a specialized instrument called an anoscope. During this procedure, if any abnormal tissue is identified, a biopsy is taken for further analysis. This code is essential for billing and documentation purposes, as it specifies both the diagnostic aspect of the procedure and the additional biopsy component.
For CPT code 46607 (Diagnostic anoscopy & biopsy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the procedure, not the technical component.
3. Modifier 50 - Bilateral Procedure
- If the procedure is performed bilaterally, this modifier should be used to indicate that the service was performed on both sides of the body.
4. Modifier 51 - Multiple Procedures
- This modifier is used when multiple procedures are performed during the same session. It indicates that the provider performed more than one procedure on the same day.
5. Modifier 52 - Reduced Services
- Use this modifier when the service or procedure is partially reduced or eliminated at the physician's discretion. This indicates that the full service was not performed.
6. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. 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. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician on the same day.
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
- This modifier is 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
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 46607, which involves diagnostic anoscopy and biopsy, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various medical services covered by Medicare. Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they can provide detailed information on coverage policies and any potential local variations in reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 46607. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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
