CPT code 49600 is used to describe the surgical repair of an umbilical lesion, detailing the specific procedure for billing and documentation.
CPT code 49600 is used to describe the surgical procedure for the repair of an umbilical lesion. This code specifically refers to the surgical intervention aimed at correcting or addressing abnormalities or defects located at the umbilical area, which may include hernias or other types of lesions. The procedure typically involves excising the lesion and repairing the surrounding tissue to restore normal anatomy and function.
For CPT code 49600 (Repair umbilical lesion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is 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: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate 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: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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 related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during 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: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 49600 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, including CPT code 49600. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for this code. MACs are responsible for processing Medicare claims and may have local coverage determinations (LCDs) that affect the reimbursement criteria for CPT code 49600. Therefore, while Medicare does reimburse for this code, healthcare providers should consult the MPFS and their respective MACs for detailed information on coverage and payment rates.
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