2025 CPT code 46999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Unlisted procedure on the anus.
Modifiers may be applicable depending on the specific circumstances of the procedure. Consult the most recent CPT guidelines.
Medical necessity must be clearly established through comprehensive documentation that demonstrates the procedure was appropriate and necessary for the patient's condition. The documentation should justify why a specific, existing CPT code does not accurately reflect the services provided.
The physician performs a procedure on the anus not specifically listed in the CPT codebook.Thorough documentation of the procedure is the physician's responsibility to justify the use of this unlisted code.
In simple words: This code is used when a doctor performs a procedure on the anus that doesn't have a specific billing code.The doctor needs to explain exactly what they did and why this code is needed to get paid.
This CPT code reports procedures on the anus for which no other specific code exists.It is used when the performed procedure does not match any other existing, specific CPT code.Accurate documentation, including a detailed description of the procedure performed, comparison to similar coded procedures, and justification for using an unlisted code, is crucial for successful reimbursement.
Example 1: A patient presents with a complex anal fistula requiring a surgical repair not adequately described by existing CPT codes. The surgeon performs a complex surgical repair, and 46999 is used with detailed operative notes explaining the procedure and its differences from other, similar procedures., A patient presents with a rare anal anomaly requiring a specialized procedure.The physician performs the procedure, and 46999 is used, accompanied by detailed documentation comparing the procedure to existing codes and justifying the use of the unlisted code., A patient requires an innovative minimally invasive procedure for treating a specific anal condition. The surgeon uses a novel technique, and 46999 is used to report this unlisted procedure, along with extensive documentation detailing the technique and comparing it to existing procedures.
* Detailed operative report describing the procedure performed.* Justification for using an unlisted code, with comparisons to similar procedures.* Preoperative and postoperative diagnoses.* Photographs or other visual aids may be helpful.
** Because this is an unlisted code, the accuracy of reimbursement hinges heavily on the completeness and clarity of documentation supporting the medical necessity and the procedure's description.Always consult with your payer for specific billing requirements and local coverage determinations.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The relative value units (RVUs) for this code will vary depending on the specific procedure performed and the payer.Documentation justifying the unlisted code is essential for accurate reimbursement.
- Global Days: The global period will depend on the specific procedure.This needs to be clearly documented.
- Payment Status: Active
- Modifier TC rule: The applicability of a Technical Component (TC) modifier depends on the specific procedure and should be determined based on individual payer guidelines.
- Fee Schedule: Fee schedules for unlisted procedures vary significantly based on payer and procedure. Documentation supporting the billed amount is critical for reimbursement.
- Specialties:Colorectal surgery, general surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center