CPT code 49061 is a medical billing code for draining a fluid collection through the skin, specifically for abdominal abscesses.
CPT code 49061 is used to describe the procedure of draining a percutaneous retroperitoneal abscess. This involves using a needle or catheter to access and remove fluid or pus from an abscess located in the retroperitoneal space, which is the area behind the abdominal cavity. This procedure is typically performed to alleviate symptoms, prevent complications, and promote healing.
For CPT code 49061, which involves the drainage of a percutaneous retroperitoneal abscess, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty.
2. Modifier 26 (Professional Component): Indicates that only the professional component of the service was provided. This is relevant when the procedure involves both a technical and a professional component.
3. Modifier 52 (Reduced Services): Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. 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.
5. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues.
6. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
9. 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.
10. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon was required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
14. Modifier 99 (Multiple Modifiers): Indicates that multiple modifiers are applicable to the procedure. This is used when more than four modifiers are necessary.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 49061 is reimbursable by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and payment may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 49061. Schedule a demo today to see how RevFind can help you identify and recover underpayments from individual payers.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
