CPT code 46744 is for the surgical repair of a cloacal anomaly, a complex condition affecting the urinary and reproductive systems.
CPT code 46744 is for the surgical repair of a cloacal anomaly, which is a congenital condition where the rectum, vagina, and urinary tract are fused into a single opening. This procedure involves reconstructing the affected areas to restore normal function and anatomy.
For CPT code 46744, which pertains to the repair of a cloacal anomaly, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as the complexity of the patient's condition or the need for additional surgical time.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that the repair of the cloacal anomaly was one of several procedures performed.
3. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full scope of the procedure was not necessary or feasible.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but had to be discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the repair of the cloacal anomaly was a separate and necessary service.
6. Modifier 62 - Two Surgeons
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure. This indicates that the repair required the expertise of two surgeons.
7. Modifier 66 - Surgical Team
- Use this modifier when the procedure requires a surgical team due to its complexity. This indicates that the repair of the cloacal anomaly necessitated a coordinated effort by multiple healthcare professionals.
8. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the procedure. It indicates that the repair of the cloacal anomaly was performed more than once by the same provider.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier when a different physician repeats the procedure. This indicates that the repair was performed again by another provider.
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
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period. This indicates that the repair of the cloacal anomaly required additional surgical intervention.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure. It indicates that the repair of the cloacal anomaly was unrelated to the subsequent procedure.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required to help with the procedure. This indicates that the repair of the cloacal anomaly needed additional surgical assistance.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required. This indicates that the repair of the cloacal anomaly required minimal but necessary assistance.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available. It indicates that the repair of the cloacal anomaly required an assistant surgeon due to the unavailability of a resident.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery. This indicates that the repair of the cloacal anomaly required the assistance of these healthcare professionals.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate representation of the services provided.
The CPT code 46744 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the respective Medicare Administrative Contractor (MAC) for any local coverage determinations or specific guidelines that may affect reimbursement for CPT code 46744.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 46744, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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