CPT code 46712 is a medical billing code for a double procedure involving the repair of a vaginal pouch.
CPT code 46712 is used to describe a surgical procedure involving the repair of a vaginal pouch, specifically when it is performed as a double procedure. This code indicates that the healthcare provider is addressing issues related to the vaginal pouch, which may involve reconstructive techniques to restore function or alleviate complications.
For CPT code 46712, 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.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
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.
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 (more than two) is required to perform a specific procedure.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician subsequent to the original procedure.
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 related procedure is performed 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 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 these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 46712 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Each MAC may have additional local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed.
To verify if CPT code 46712 is reimbursed, you should:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database to see if CPT code 46712 is listed and review the associated reimbursement details.
2. Consult Your MAC: Each MAC may have specific guidelines or coverage determinations that impact the reimbursement of CPT code 46712. It's essential to review any relevant LCDs or policies issued by your MAC.
By following these steps, you can determine if CPT code 46712 is eligible for reimbursement under Medicare.
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