CPT code 49495 is used for reporting the repair of an inguinal hernia in infants, specifically when it is reducible.
CPT code 49495 is used to describe the procedure of repairing an inguinal hernia in an infant or child, specifically when the hernia is reducible. This means that the hernia can be pushed back into the abdominal cavity without the need for more invasive surgical intervention. The code indicates that the repair is performed using a technique that is appropriate for pediatric patients, ensuring that the procedure is tailored to the unique anatomical and physiological considerations of infants.
Certainly! Here are the modifiers that could be used with the CPT code 49495:
1. Modifier 22 (Increased Procedural Services)
- Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 50 (Bilateral Procedure)
- Applied when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures)
- Used when multiple procedures are performed during the same surgical session. This modifier helps indicate that more than one procedure was carried out.
4. Modifier 52 (Reduced Services)
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. 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.
7. Modifier 76 (Repeat Procedure by Same Physician)
- Applied when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 (Repeat Procedure by Another Physician)
- Used when the same procedure is repeated by a different physician on the same day.
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)
- Applied when a patient returns 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)
- Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
11. Modifier 80 (Assistant Surgeon)
- Applied when an assistant surgeon is required during the procedure.
12. Modifier 81 (Minimum Assistant Surgeon)
- Used when a minimum assistant surgeon is required during the procedure.
13. 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.
14. 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.
CPT code 49495 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, reimbursement may vary depending on factors such as geographic location and specific Medicare Administrative Contractor (MAC) policies. Healthcare providers should consult their local MAC for specific coverage and payment guidelines related to this CPT code.
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