CPT code 46750 is for the surgical repair of the anal sphincter, a procedure to restore function and integrity to this muscle.
CPT code 46750 is for the surgical repair of the anal sphincter. This procedure is typically performed to correct issues such as anal incontinence or damage to the sphincter muscle, which can occur due to trauma, childbirth, or other medical conditions. The goal of this repair is to restore normal function and improve the patient's quality of life.
For the CPT code 46750 (Repair of anal sphincter), 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 anal sphincter is more complex than usual.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. If the repair of the anal sphincter is performed along with other procedures, this modifier would be appropriate.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. If the repair of the anal sphincter is not fully completed, this modifier would be used.
4. 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 could apply if the repair of the anal sphincter is performed in a different session or location than other procedures.
5. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when the same procedure is repeated by the same physician. If the repair of the anal sphincter needs to be repeated, this modifier would be appropriate.
6. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician. If another physician needs to repeat the repair of the anal sphincter, this modifier would be used.
7. 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 of the initial repair.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period of the initial repair.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure. If an assistant is needed for the repair of the anal sphincter, this modifier would be appropriate.
10. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required. If only minimal assistance is needed for the repair, this modifier would be used.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available. This could apply to the repair of the anal sphincter if no resident is available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery. If a PA, NP, or CNS assists in the repair, this modifier would be used.
Each of these modifiers provides specific information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 46750 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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