CPT code 49566 is a medical billing code for the repair of a recurrent ventral hernia using a mesh or other materials.
CPT code 49566 is used to describe the surgical procedure for the repair of a recurrent ventral hernia using a laparoscopic approach. This code specifically indicates that the hernia, which is an abnormal bulging of tissue through a weak spot in the abdominal wall, has returned after a previous repair. The laparoscopic technique involves making small incisions and using a camera and specialized instruments to perform the surgery, which typically results in less postoperative pain and quicker recovery for the patient compared to open surgery.
For CPT code 49566, which pertains to the rerepair of a ventral 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 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure is planned or staged during the postoperative period of the initial procedure.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when the same procedure is repeated by a different provider.
7. 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 surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure performed during the postoperative period was unrelated to the initial procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for the procedure.
11. 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.
12. 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.
The CPT code 49566 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. To determine the specific reimbursement rate, you should refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for various services covered by Medicare.
Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 49566.
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