CPT code 49553 is for the initial repair of a femoral hernia that is blocked, detailing the specific procedure for billing and documentation.
CPT code 49553 is used to describe the surgical procedure for the repair of a femoral hernia that is initially blocked or incarcerated. This code indicates that the hernia is not reducible, meaning it cannot be pushed back into the abdomen, and requires a surgical intervention to correct the issue. The procedure typically involves making an incision in the groin area to access the hernia, freeing any trapped tissue, and then repairing the defect in the femoral canal to prevent future occurrences.
For CPT code 49553, which pertains to the repair of a femoral hernia, initial, with mesh or other prosthesis, via any approach (e.g., open, laparoscopic), the following modifiers may be applicable:
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 additional time and effort.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. 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. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Applied when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when the same procedure is repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician subsequent to the original procedure.
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: Used when a patient requires a 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: Used when a procedure performed during the postoperative period is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because 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 these non-physician practitioners assist in 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 49553 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. To verify if CPT code 49553 is reimbursed, you should first look it up in the MPFS database. Additionally, since MACs are responsible for processing Medicare claims and can have region-specific guidelines, it is advisable to contact your local MAC for confirmation and any additional requirements or documentation needed for reimbursement.
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