CPT code 49610 is a medical billing code used to describe the surgical repair of an umbilical lesion.
CPT code 49610 is used to describe the surgical procedure for the repair of an umbilical lesion. This code specifically indicates that the healthcare provider has performed a surgical intervention to correct or fix a problem related to the umbilical area, which may involve conditions such as hernias or other abnormalities.
When billing for CPT code 49610 (Repair umbilical lesion), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure was performed bilaterally (on both sides of the body).
3. Modifier 51 - Multiple Procedures: Use this modifier 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 the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team: Apply this modifier if the procedure requires the use of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
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: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 49610, which involves the repair of an umbilical lesion, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 49610. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 49610.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 49610. Don't let underpayments slip through the cracks—schedule a demo today and see how RevFind can optimize your revenue cycle management.
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
