CPT code 49557 is used to describe the surgical procedure for repairing a recurrent femoral hernia that is obstructed.
CPT code 49557 is used to describe the surgical procedure for the repair of a recurrent femoral hernia that has become incarcerated or obstructed. This code indicates that the hernia repair is being performed on a previously repaired site, and it involves addressing complications such as blockage, which may require more complex surgical techniques to ensure proper closure and prevent future issues.
For CPT code 49557, which pertains to the rerepair of a femoral hernia, 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: Indicates that the procedure was 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: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Indicates 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 procedure.
8. Modifier 66 - Surgical Team: Indicates that a surgical team was required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service again on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was 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 patient returns to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for 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: Indicates that a non-physician provider assisted 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 49557 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 and procedures covered by Medicare, along with their corresponding reimbursement rates.
To verify if CPT code 49557 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are private health care insurers contracted by CMS to process Medicare claims, may have specific local coverage determinations (LCDs) that affect reimbursement.
Therefore, to confirm if CPT code 49557 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific coverage policies or guidelines that apply to your geographic area.
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