CPT code 49550 is for the surgical repair of an initial reducible hernia, detailing the procedure for healthcare billing and documentation.
CPT code 49550 is used to describe the surgical procedure for the initial repair of a hernia that has been reduced. This code specifically refers to the process of correcting a hernia, which is a condition where an organ or tissue protrudes through an abnormal opening in the body. The "initial" aspect indicates that this is the first time the hernia is being addressed surgically. This procedure is typically performed to alleviate symptoms and prevent complications associated with the hernia.
For CPT code 49550, which pertains to the repair of a recurrent hernia, initial reduction, 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 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is 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 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician on the same day.
11. 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.
12. 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.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 49550 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 49550 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect reimbursement. Therefore, it is crucial to review both the MPFS and any relevant LCDs issued by your regional MAC to confirm if CPT code 49550 is eligible for reimbursement under Medicare.
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 49550. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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