CPT code 46937 is a medical billing code for cryotherapy treatment of a rectal lesion, used to describe the procedure for insurance and record-keeping.
CPT code 46937 is a procedure that involves the use of cryotherapy to treat a lesion located in the rectal area. This technique typically entails applying extreme cold to the lesion, which helps to destroy abnormal tissue and promote healing. It is often utilized for conditions such as rectal polyps or other localized growths, providing a minimally invasive option for healthcare providers to manage rectal lesions effectively.
For CPT code 46937 (Cryotherapy of rectal lesion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as the size or number of lesions treated.
2. Modifier 50 - Bilateral Procedure: If the cryotherapy was performed on lesions located on both sides of the rectum, this modifier should be used.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same session, this modifier should be applied to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the cryotherapy was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the cryotherapy was repeated by the same physician on the same day, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If the cryotherapy was repeated by a different physician on the same day, this modifier should be applied.
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: Use this modifier if the patient had to return for additional cryotherapy due to complications or incomplete treatment.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the cryotherapy was performed during the postoperative period of another procedure but is unrelated to the initial procedure, this modifier should be used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier should be applied.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: If a non-physician provider assisted in the surgery, this modifier should be used.
14. Modifier LT - Left Side: If the cryotherapy was performed on a lesion located on the left side of the rectum, this modifier should be used.
15. Modifier RT - Right Side: If the cryotherapy was performed on a lesion located on the right side of the rectum, this modifier should be used.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 46937, which pertains to cryotherapy of rectal lesion, is reimbursed by Medicare. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement details and any potential variations can be influenced by the Medicare Administrative Contractor (MAC) responsible for the geographic region where the service is provided. It is advisable to consult the MPFS and the relevant MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 46937.
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