CPT code 46716 is for reporting the repair of an anal or vestibular fistula, a procedure to correct abnormal openings in these areas.
CPT code 46716 is used to describe the procedure of repairing an anal or vestibular fistula. This code specifically refers to the surgical intervention aimed at closing an abnormal connection between the anal canal and the skin or between the vestibule and the skin, which can occur due to various medical conditions. The procedure typically involves excising the fistulous tract and suturing the surrounding tissue to restore normal anatomy and function.
Certainly! Here are the modifiers that could be used with CPT code 46716:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. 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.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform a procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
12. 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.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.
15. 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.
16. 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.
The CPT code 46716 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, it is important to note that the final determination of reimbursement for CPT code 46716 may also depend on the policies of the local Medicare Administrative Contractor (MAC). MACs are responsible for interpreting national policies and making coverage decisions based on local needs and circumstances. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 46716.
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