CPT code 46940 is for the treatment of anal fissure, detailing the specific procedure for billing and documentation in healthcare.
CPT code 46940 is for the treatment of an anal fissure. This procedure typically involves surgical intervention to repair the fissure, which is a small tear in the lining of the anal canal. The treatment aims to alleviate pain, promote healing, and prevent recurrence of the fissure.
For CPT code 46940, which pertains to the treatment of anal fissure, 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 be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
10. 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.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
13. 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.
14. 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.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 46940 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for this CPT code. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 46940.
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