CPT code 49591 is for the repair of an abdominal hernia measuring less than 3 cm, using a specific technique for treatment.
CPT code 49591 is used to describe the repair of an abdominal hernia that is recurrent and measures less than 3 centimeters. This procedure involves the surgical correction of the hernia, which has returned after a previous repair, ensuring that the abdominal wall is reinforced to prevent further complications.
For CPT code 49591, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 (Bilateral Procedure): This modifier is used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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 used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier LT (Left Side): This modifier is used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT (Right Side): This modifier is used to indicate that the procedure was performed on the right side of the body.
12. Modifier XS (Separate Structure): This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.
13. Modifier XE (Separate Encounter): This modifier is used to indicate that a service is distinct because it was performed during a separate encounter.
14. Modifier XP (Separate Practitioner): This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.
15. Modifier XU (Unusual Non-Overlapping Service): This modifier is used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the procedure performed and ensure accurate billing and reimbursement. Proper use of modifiers can prevent claim denials and ensure compliance with payer requirements.
CPT code 49591 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 49591, and by individual payer. Schedule a demo today to see how RevFind can help you identify and recover lost revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
