CPT code 46754 is for the removal of sutures from the anus, used for billing and documentation in healthcare services.
CPT code 46754 is for the removal of sutures from the anus. This procedure typically involves the careful extraction of stitches that were previously placed during surgical interventions or repairs in the anal region. It is important for healthcare providers to document this procedure accurately for proper billing and to ensure that the patient's medical record reflects the care provided.
When dealing with CPT code 46754 for the removal of suture from the anus, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more effort or time than usual.
2. Modifier 50 - Bilateral Procedure
- If the procedure was performed bilaterally, this modifier should be appended.
3. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same session.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- This modifier is applicable if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used if the patient had to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was unrelated to the original procedure and occurred during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is applicable if an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
15. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Apply this modifier if the procedure was performed on the left side.
16. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Use this modifier if the procedure was performed on the right side.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
When determining if CPT code 46754 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To verify if CPT code 46754 is reimbursed, you should:
1. Check the MPFS: Access the MPFS database on the Centers for Medicare & Medicaid Services (CMS) website. Enter the specific CPT code 46754 to see if it is listed and to review the associated reimbursement rates.
2. Consult Your MAC: Each MAC may have specific coverage policies and guidelines. Contact your regional MAC or visit their website to confirm if CPT code 46754 is covered and to understand any additional documentation or criteria that may be required for reimbursement.
By following these steps, you can determine if CPT code 46754 is reimbursed by Medicare and ensure compliance with all relevant billing and coding guidelines.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 46754, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
