CPT code 49492 is used for reporting the repair of a hernia in a premature infant that is blocked or obstructed.
CPT code 49492 is used to describe the repair of an inguinal hernia in a premature infant that is obstructed or blocked. This procedure involves surgical intervention to correct the hernia, which is a condition where tissue protrudes through a weak spot in the abdominal muscles, and is particularly critical in premature infants due to their increased vulnerability.
When dealing with CPT code 49492, which pertains to the repair of an inguinal hernia in a premature infant with a blocked condition, several modifiers may be applicable. Below is a list of potential modifiers and 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 the complexity of the patient's condition or other complicating factors.
2. Modifier 50 - Bilateral Procedure
- If the procedure was performed on both sides of the body, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures
- This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the primary procedure was accompanied by additional procedures.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full procedure was not necessary or could not be completed.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
7. Modifier 76 - Repeat Procedure by Same Physician
- If the same procedure was repeated by the same physician, this modifier should be used to indicate the repetition.
8. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- If an assistant surgeon was necessary for the procedure, this modifier should be appended to indicate their involvement.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required because a qualified resident surgeon was not available.
14. Modifier 99 - Multiple Modifiers
- If more than one modifier is necessary to describe the procedure, this modifier should be used to indicate the presence of multiple modifiers.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the services provided.
Determining whether CPT code 49492 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their corresponding reimbursement rates.
To ascertain if CPT code 49492 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or through specific software tools designed for this purpose. Additionally, your regional MAC may have specific guidelines or policies that affect the reimbursement status of CPT code 49492.
In summary, while the MPFS is the primary resource for determining Medicare reimbursement, consulting your regional MAC is also crucial for the most accurate and up-to-date information.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 49492, and by individual payer. Don't let underpayments slip through the cracks. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
