CPT code 46748 is a medical billing code used for the repair of a cloacal anomaly in patients, ensuring accurate healthcare reimbursement.
CPT code 46748 is used to describe the surgical procedure for the repair of a cloacal anomaly, which is a congenital condition where the rectum, vagina, and urinary tract are improperly formed and share a common opening. This code indicates that a healthcare provider has performed a surgical intervention to correct this complex defect, restoring normal function and anatomy.
For CPT code 46748 (Repair of cloacal anomaly), 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. This could apply if the repair of the cloacal anomaly is more complex than usual.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This may be relevant if the repair of the cloacal anomaly is performed alongside other surgical procedures.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could apply if the full extent of the cloacal anomaly repair is not completed.
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. This may be necessary if the repair of the cloacal anomaly is performed in a separate session from other procedures.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. This could be relevant if the repair requires the expertise of two surgeons.
7. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure. This might be necessary for particularly complex repairs of cloacal anomalies.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service 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: Used if the patient needs to 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: 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 healthcare professionals assist 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 46748 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC may have specific guidelines and coverage determinations that impact whether and how a particular CPT code is reimbursed.
Therefore, it is advisable to consult both the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 46748.
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