CPT code 49405 is for the procedure of imaging catheter fluid collection from a viscous substance in a medical setting.
CPT code 49405 is used to describe the procedure of image-guided catheter placement for the collection of fluid from a viscous (thick) substance within a body cavity. This code indicates that a healthcare provider has utilized imaging techniques to assist in the accurate placement of a catheter, allowing for the extraction of fluid that may be difficult to obtain due to its consistency. This procedure is often performed to diagnose or treat various medical conditions.
For CPT code 49405, the following modifiers may be applicable:
1. Modifier 26 - Professional Component
- Used when only the professional component of the service is being billed, typically by the physician.
2. Modifier TC - Technical Component
- Used when only the technical component of the service is being billed, typically by the facility.
3. Modifier 52 - Reduced Services
- Used 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 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.
6. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by another physician subsequent to the original procedure.
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
- Used when a related procedure is performed during the postoperative period of the initial procedure.
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
- Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 49405 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 and the corresponding payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 49405. MACs are responsible for processing Medicare claims and can provide further guidance on any regional variations or additional documentation requirements needed for reimbursement.
It is advisable to consult the MPFS and your local MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 49405.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 49405. Schedule a demo today to see how RevFind can help you recover revenue from individual payers and ensure you're getting paid what you deserve.
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
