CPT code 64746 is for the procedure involving the cutting or removal of the phrenic nerve, often used in surgical interventions.
CPT code 64746 is used to describe the surgical procedure involving the transection or avulsion of the phrenic nerve. This code is applicable when a healthcare provider performs a surgical intervention to either cut (transect) or remove (avulse) the phrenic nerve, which is responsible for controlling the diaphragm and plays a crucial role in breathing. This procedure might be necessary in cases where there is a need to address certain medical conditions affecting respiratory function or to manage chronic pain. Proper documentation and coding of this procedure are essential for accurate billing and reimbursement in the healthcare revenue cycle.
For CPT code 64746, which involves the transection or avulsion of the phrenic nerve, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more effort or time than typically expected. Documentation must support the increased complexity.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier indicates that it was a bilateral procedure.
3. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was conducted.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the procedure is repeated by a different physician on the same day.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient requires an unplanned return to the operating room for a related procedure during the postoperative period, this modifier should be used.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be applied.
10. Modifier 81 (Minimum Assistant Surgeon): Use this modifier when a minimum assistant surgeon is necessary for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer guidelines. Proper documentation is essential to justify the use of any modifier.
CPT code 64746, which involves the transection or avulsion of the phrenic nerve, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 64746 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 64746. They may have local coverage determinations (LCDs) that affect whether this code is reimbursed in certain jurisdictions. Therefore, it is essential for healthcare providers to check with their respective MAC to ensure compliance with any regional policies or requirements that might impact reimbursement for this specific procedure.
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