CPT code 49613 is for the repair of a hernia with a size of less than 3 cm, using an open surgical approach.
CPT code 49613 is for the repair of an abdominal hernia that is recurrent and measures less than 3 centimeters in diameter. This procedure involves the surgical correction of the hernia, which is a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. The code specifically indicates that the hernia being addressed is not the first occurrence, highlighting the complexity and potential challenges associated with recurrent hernias.
For CPT code 49613, 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 complications or other factors that increase the complexity of the repair.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate patient encounters.
5. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
6. Modifier 66 (Surgical Team): Used when a team of surgeons is required to perform the procedure due to its complexity.
7. Modifier 76 (Repeat Procedure by Same Physician): Indicates that the same physician performed the procedure more than once on the same day.
8. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure is repeated by a different physician on the same day.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates an unplanned 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): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required to help perform the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): Indicates that a minimum assistant surgeon is required for the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
The CPT code 49613 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice.
Additionally, reimbursement for CPT code 49613 may vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information regarding the reimbursement of CPT code 49613.
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