Medicare Benefits Schedule - Item 46101

Excision of burnt tissue, if the area of burn excised involves not more than 1% of the total body surface

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $371.50 Benefit: 75% = $278.65 85% = $315.80

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

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Item 46100 is a modifier item that provides extra funding for burns involving the hands, face and anterior neck.

The modifier item can be co-claimed with any of items 46101 to 46135 (other than item 46112 or 46124), where excision of burnt tissue or definitive burn wound closure involves greater than 1% of the hands, face or anterior neck.

The modifier items cannot be co-claimed with whole-of-face burns items 46112, 46124 or 46136.

The derived fee for claims including the modifier item will be an additional 40% of the fee for the co-claimed service.

Claiming the modifier item

The modifier item (46100) should be claimed immediately after the burns excision or closure item it is associated with.

If multiple burns excision/closure item are eligible to be claimed with the modifier items (i.e. the excision of burnt tissue or definitive burn wound closure involves greater than 1% of the hands, face or anterior neck for multiple items) then the modifier item should be claimed immediately after each of the burns excision/closure items it is associated with. However, where multiple burns excision/closure items are claimed, the modifier item may not necessarily apply to each of the items.

For example, for a claim involving burns excision and closure items 46101, 46114 and 46127, where the modifier item only applies to items 46101 and 46114, the following items should be claimed:

When claiming the modifier item with one of the burns excision or closure items:

• the modifier item and the associated burns excision or closure item is treated as one service for the purpose of the Multiple Operation Rule
• the derived fee resulting from claiming the modifier item is calculated before the Multiple Operation Rule is applied/calculated.

Related Items: 46100 46101 46102 46103 46104 46105 46106 46107 46108 46109 46110 46111 46112 46113 46114 46115 46116 46117 46118 46119 46120 46121 46122 46123 46124 46125 46126 46127 46128 46129 46130 46131 46132 46133 46134 46135 46136

Only one item can be claimed from the excision of burnt tissue items (items 46101 to 46111) for one provider in one operation.

Item 46112, for excision of burnt tissue involving whole of face, may be claimed with one excision of burnt tissue item (items 46101 to 46111), based on the percentage of total body surface (excluding the face).

For any size of burn, each surgeon can work with another surgeon and each surgeon chooses the excision item from items 46101 to 46112 based on the area that they, as an individual surgeon, have excised.

Where two surgeons are claiming item numbers, the sum of items of each of the surgeons should match the total percentage surface area of burn excised for that patient.

Excision of burnt tissue items (items 46101 to 46112) can be co-claimed with immediate closure items (items 46113 to 46124), but not with delayed definitive closure items (items 46130 to 46136).

When immediate closure is being performed, if it is indicated, both an immediate closure item (items 46113 to 46124) and a non-excisional debridement item (items 46125 to 46129) can be claimed.

Delayed definitive closure items (items 46130 to 46136) cannot be co-claimed with excision of burnt tissue items (items 46101 to 46112), immediate closure items (items 46113 to 46124) or non-excisional debridement items (items 46125 to 46129).

The modifier item (46100) can be co-claimed with the excision of burnt tissue items, immediate closure items, the non-excisional debridement items and the delayed closure items, but it cannot to co-claimed with whole-of-face items 46112, 46124 or 46136.

Related Items: 46100 46101 46102 46103 46104 46105 46106 46107 46108 46109 46110 46111 46112 46113 46114 46115 46116 46117 46118 46119 46120 46121 46122 46123 46124 46125 46126 46127 46128 46129 46130 46131 46132 46133 46134 46135 46136