CPT code 46942 is used for the treatment of anal fissure, detailing the specific procedure performed for billing and documentation purposes.
CPT code 46942 is used to describe the treatment of an anal fissure, which is a small tear in the lining of the anus. This code specifically refers to a surgical procedure that may involve techniques such as lateral internal sphincterotomy or other methods to alleviate pain and promote healing of the fissure. It is typically utilized by healthcare providers to document and bill for the surgical intervention required to address this condition.
For CPT code 46942, 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
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 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 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
10. 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.
11. 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.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 46942 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and any applicable modifiers that may affect reimbursement.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for this CPT code. Providers should consult their respective MAC for any region-specific guidelines or additional documentation requirements to ensure proper reimbursement for CPT code 46942.
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