CPT code 49185 is used for sclerotherapy of fluid collections, a procedure to treat abnormal fluid buildup in the body.
CPT code 49185 is used to describe the procedure of sclerotherapy for the treatment of fluid collections in the abdominal cavity. This involves the injection of a sclerosing agent into the fluid collection to promote adhesion of the tissue and reduce the size of the fluid pocket. This code is specifically applicable when the procedure is performed under imaging guidance, ensuring accurate placement of the sclerosing agent.
For CPT code 49185 (Sclerotx fluid collection), 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 26 - Professional Component: Indicates that the service provided was the professional component only, such as the interpretation of a diagnostic test.
3. Modifier 50 - Bilateral Procedure: Used if the procedure was performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Indicates that multiple procedures were performed during the same session.
5. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure: Indicates that a procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. 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.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Used when a related procedure during the postoperative period requires a return to the operating room.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for 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 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 49185, which pertains to sclerotherapy of a fluid collection, is reimbursed by Medicare, but the reimbursement specifics can vary. To determine if CPT code 49185 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database. Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) as they may have specific guidelines or coverage determinations that affect reimbursement. Each MAC can have different policies, so checking with the appropriate MAC for your region is crucial to ensure accurate billing and reimbursement.
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