CPT code 46740 is for the surgical construction of an absent anus, a procedure to create an opening for bowel elimination.
CPT code 46740 is used to describe the surgical procedure for the construction of an absent anus, a condition known as anal atresia. This code specifically refers to the surgical intervention that creates a new anal opening for patients who are born without a functional anus, allowing for proper bowel function and waste elimination.
For CPT code 46740, "Construction of absent anus," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work involved in the construction of the absent anus.
2. Modifier 52 (Reduced Services): Applied when the procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if only part of the construction was completed due to patient condition or other factors.
3. Modifier 53 (Discontinued Procedure): Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform distinct parts of the procedure, this modifier indicates that both surgeons are equally responsible for the procedure.
5. Modifier 66 (Surgical Team): Applied when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 (Repeat Procedure by Same Physician): Used if the same physician needs to repeat the procedure for the same patient.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied if a different physician needs to repeat the procedure for the same patient.
8. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the services provided.
CPT code 46740 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. Healthcare providers should consult their local MAC for detailed coverage guidelines and documentation requirements when billing for this procedure.
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