CPT code 49320 is a diagnostic laparoscopic procedure used to separate organs or tissues for examination or treatment.
CPT code 49320 is used to describe a diagnostic laparoscopic procedure that involves the separation of organs or tissues within the abdominal cavity. This code indicates that the procedure is performed using minimally invasive techniques, allowing for a thorough examination and potential treatment of conditions affecting the abdominal organs without the need for a large incision.
For CPT code 49320, 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 time.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than usually required.
4. Modifier 53 (Discontinued Procedure): Applied 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): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 (Surgical Team): Used when a highly complex procedure requires the skills of several physicians, often of different specialties, working together as a team.
8. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician subsequent to the original procedure.
9. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by another physician subsequent to the original procedure.
10. 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.
11. 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.
12. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 49320 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. To determine the exact reimbursement for CPT code 49320, healthcare providers should consult the MPFS for the current year.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on the reimbursement for CPT code 49320. Providers should verify with their respective MAC to ensure compliance with local coverage determinations and any additional documentation requirements that may impact reimbursement.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 49320, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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