CPT code 49555 is a medical billing code used for the repair of a recurrent femoral hernia.
CPT code 49555 is used to describe the surgical procedure for the rerepair of a femoral hernia. This code indicates that the surgeon is performing a corrective operation to address a previously repaired femoral hernia that has recurred. The procedure involves reducing the hernia, which means pushing the protruding tissue back into place, and may include reinforcing the area to prevent future occurrences.
When billing for CPT code 49555, which pertains to the rerepair of a femoral hernia with reduction, it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 49555, along with 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 case or unusual circumstances.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure is unrelated to the original surgery and occurs during the postoperative period.
10. Modifier LT - Left Side
- This modifier is used to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- This modifier is used to specify that the procedure was performed on the right side of the body.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each modifier serves a specific purpose and should be used accurately to reflect the circumstances of the procedure. Proper use of modifiers can help avoid claim denials and ensure appropriate reimbursement.
CPT code 49555 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, reimbursement may vary depending on factors such as geographic location and the specific Medicare Administrative Contractor (MAC) processing the claim. Providers should consult their local MAC for specific coverage and payment guidelines related to CPT 49555.
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