CPT code 46746 is for the surgical repair of a cloacal anomaly, a complex condition affecting the urinary and reproductive systems.
CPT code 46746 is used to describe the surgical procedure for the repair of a cloacal anomaly. This condition involves a congenital defect where the rectum, vagina, and urinary tract are fused together, leading to a single opening. The procedure aims to separate these structures and restore normal anatomy, allowing for proper function of the urinary and gastrointestinal systems.
For CPT code 46746, "Repair of 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures
- This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services
- Apply this modifier when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should explain why the service was reduced.
4. Modifier 53 - Discontinued Procedure
- Use this modifier 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
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It helps to avoid bundling issues.
6. Modifier 62 - Two Surgeons
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team
- Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when the same physician needs to repeat the procedure for the same patient on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier when a procedure is repeated by another 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
- Use this modifier when the patient requires a return to the operating room for a related procedure during the postoperative period.
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.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when an assistant surgeon is required on a minimal basis during 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
- Apply this modifier 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 46746, which pertains to the repair of a cloacal anomaly, is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for this procedure. Additionally, the final decision on reimbursement can be influenced by the local coverage determinations (LCDs) set forth by the Medicare Administrative Contractor (MAC) in your region. It is essential to consult the MPFS and your specific MAC's guidelines to ensure compliance and accurate reimbursement for CPT code 46746.
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 46746, 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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