CPT code 49496 is used to describe the repair of a hernia in infants, specifically when it is blocked or incarcerated.
CPT code 49496 is used to describe the surgical procedure for repairing an inguinal hernia in an infant or child that has become incarcerated or obstructed. This code specifically indicates that the hernia repair is being performed due to complications, such as blockage, which may require a more complex approach than a standard hernia repair.
For CPT code 49496, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 (Bilateral Procedure): This modifier is used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 (Discontinued Procedure): This modifier is used 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): This modifier is 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): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): This modifier is used 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): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is 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, and a qualified resident surgeon is not available.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 49496 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 49496. The MACs are responsible for processing Medicare claims and can provide detailed guidance on coverage and payment policies.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 49496, 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
