CPT code 49255 is for the surgical removal of omentum, a fold of tissue in the abdomen, often performed to treat various medical conditions.
CPT code 49255 is for the surgical procedure involving the removal of the omentum, which is a fold of peritoneum extending from the stomach. This procedure may be performed for various reasons, including the treatment of certain abdominal conditions or diseases. The code specifically indicates that the removal is done through an open surgical approach, and it may involve additional procedures depending on the complexity of the case.
When billing for CPT code 49255 (Removal of omentum), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 49255, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services):
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity, time, or technical difficulty.
2. 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 performed, and it helps in the correct sequencing of the procedures for reimbursement purposes.
3. Modifier 59 (Distinct Procedural Service):
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly important if there is a risk of bundling with other procedures.
4. Modifier 62 (Two Surgeons):
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their specific part of the procedure.
5. Modifier 66 (Surgical Team):
- Use this modifier when the procedure requires the services of a surgical team due to its complexity. This indicates that multiple providers were involved in the surgery.
6. Modifier 76 (Repeat Procedure by Same Physician):
- Apply this modifier if the same physician needs to repeat the procedure on the same day. This helps in distinguishing the repeat procedure from the initial one.
7. Modifier 77 (Repeat Procedure by Another Physician):
- Use this modifier if a different physician needs to repeat the procedure on the same day. This indicates that the repeat procedure was necessary and performed by another provider.
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):
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period. This indicates that the return was unplanned and related to the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure. This helps in distinguishing the unrelated service from the postoperative care of the initial procedure.
10. Modifier 80 (Assistant Surgeon):
- Apply this modifier when an assistant surgeon is required to help with the procedure. This indicates that another surgeon assisted the primary surgeon during the operation.
11. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier when a minimum assistant surgeon is required for the procedure. This indicates that the assistance was minimal but necessary.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- Apply this modifier when an assistant surgeon is required because a qualified resident surgeon was not available. This indicates the necessity of the assistant surgeon due to the unavailability of a resident.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Use this modifier when a non-physician provider, such as a physician assistant, nurse practitioner, or clinical nurse specialist, assists in the surgery. This indicates the involvement of these specific types of providers.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the removal of the omentum procedure.
CPT code 49255 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for the provider's region and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). Providers should consult their MAC for specific coverage and payment information related to CPT 49255.
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