CPT code 49582 is for repairing an umbilical hernia in patients under 5 years old, detailing the specific procedure for billing and documentation.
CPT code 49582 is used to describe the surgical repair of an umbilical hernia in a patient who is less than 5 years old. This procedure involves closing the defect in the abdominal wall where the hernia has occurred, typically through a small incision. The code specifically indicates that the repair is for a hernia located at the umbilicus (navel) and is applicable to pediatric patients.
For CPT code 49582, which pertains to the repair of an umbilical hernia in patients younger than 5 years, 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. This could be due to factors such as increased complexity or difficulty.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier should be appended to indicate that the same procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that multiple services were provided.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier should be used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be used to indicate that the procedure was repeated by another 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: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended to indicate the involvement of an assistant.
10. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
11. 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 is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 49582 is reimbursable by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that Medicare covers the procedure. However, coverage and reimbursement may vary depending on specific circumstances and medical necessity. Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for detailed guidance on billing and reimbursement policies for this code.
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