CPT code 46922 is for the excision of anal lesion(s), detailing the specific procedure for billing and documentation in healthcare.
CPT code 46922 is for the excision of anal lesion(s). This procedure involves the surgical removal of abnormal growths or lesions located in the anal area. It is typically performed to diagnose or treat conditions such as anal warts, polyps, or other skin abnormalities. The excision may vary in complexity depending on the size and type of the lesion being removed.
For CPT code 46922, which pertains to the excision of anal lesion(s), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or difficulty.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both sides of the body. This is relevant if lesions are present on both sides of the anal area.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This is applicable if other procedures are performed in addition to the excision of anal lesions.
4. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion. This could occur if the full excision is not necessary or feasible.
5. Modifier 59 (Distinct Procedural Service): Applied to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is relevant if the excision of anal lesions is performed separately from other procedures.
6. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician. This could be relevant if additional lesions are excised in a subsequent session.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician. This might be relevant in a multi-specialty practice or hospital setting.
8. 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.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a non-physician practitioner 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 46922, which involves the excision of anal lesion(s), is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MACs are responsible for processing Medicare claims and can provide further clarification on coverage and payment details for CPT code 46922.
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 46922. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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