CPT code 49570 is for the surgical repair of an epigastric hernia, specifically involving its reduction.
CPT code 49570 is used to describe the surgical procedure for the repair of an epigastric hernia, specifically when the hernia is reduced. This means that the surgeon is correcting the hernia by pushing the protruding tissue back into its proper place and then repairing the abdominal wall to prevent future occurrences. This procedure is typically performed under anesthesia and may involve suturing or using mesh to reinforce the area.
Certainly! Here are the modifiers that could be used with CPT code 49570:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the repair.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the epigastric hernia repair 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 the epigastric hernia repair was one of several procedures.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the epigastric hernia repair was separate from other procedures.
5. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
6. Modifier 66 - Surgical Team
- Use this modifier when the procedure requires the skills of a surgical team, indicating that the epigastric hernia repair was complex and necessitated multiple professionals.
7. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the epigastric hernia repair procedure within a short period.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the epigastric hernia repair procedure within a short period.
9. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient needs to 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
- This modifier is used when the physician performs an unrelated procedure during the postoperative period of the initial surgery.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help to provide additional information about the circumstances under which the epigastric hernia repair was performed, ensuring accurate billing and reimbursement.
CPT code 49570 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which means it is eligible for payment under Medicare Part B. However, reimbursement may vary depending on factors such as geographic location, place of service, and any applicable modifiers. Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage and payment guidelines related to CPT 49570.
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