CPT code 49428 is for the ligation of a shunt, a procedure to close off an abnormal blood vessel connection in the body.
CPT code 49428 is used to describe the procedure of ligation of a shunt. This involves surgically tying off a shunt, which is a passage or tube that allows fluid to flow from one part of the body to another. The ligation is typically performed to prevent the flow of fluid through the shunt, often due to complications or to redirect fluid flow for better management of a patient's condition. This procedure is commonly associated with the treatment of conditions affecting the vascular system or certain types of organ dysfunction.
For CPT code 49428 (Ligation of shunt), 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.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
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 terminated 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 or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
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 patient requires a 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 or service is performed by the same physician during the postoperative period.
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.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
Determining if CPT code 49428 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To verify if CPT code 49428 is reimbursed, you would need to:
1. Check the MPFS: Access the latest version of the MPFS, which is available on the Centers for Medicare & Medicaid Services (CMS) website. You can search for CPT code 49428 to see if it is listed and what the reimbursement rate is.
2. Consult Your MAC: Each MAC has jurisdiction over specific geographic regions and may have additional guidelines or requirements for reimbursement. Contact your regional MAC or visit their website to see if there are any specific instructions or limitations regarding CPT code 49428.
By following these steps, you can determine if CPT code 49428 is reimbursed by Medicare and understand any specific conditions or documentation requirements that may apply.
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