CPT code 49621 is for the repair of a parastomal hernia, which involves correcting a hernia near a stoma.
CPT code 49621 is used to describe the surgical procedure for the repair of a parastomal hernia with reduction. This code specifically indicates that the hernia, which occurs near a stoma (an opening created surgically for waste elimination), has been surgically corrected and the contents of the hernia have been returned to their normal position. This procedure is typically performed to alleviate complications associated with the hernia and to restore the integrity of the abdominal wall.
For CPT code 49621, which pertains to the repair of a parastomal hernia with reduction, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity of the hernia or patient-specific factors.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
3. 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 particularly useful if the hernia repair was performed in conjunction with other unrelated procedures.
4. Modifier 62 - Two Surgeons: Use this modifier if two surgeons were required to perform the procedure due to its complexity. Each surgeon would report their distinct part of the surgery.
5. Modifier 66 - Surgical Team: Apply this modifier if the procedure required a surgical team due to its complexity. This indicates that multiple professionals were involved in the surgery.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician had to repeat the procedure within a short period due to complications or recurrence.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician had to repeat the procedure within a short period.
8. Modifier 78 - Unplanned Return to the Operating Room: Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial surgery.
10. Modifier 80 - Assistant Surgeon: This modifier is used if an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 49621 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult the MPFS to determine the exact reimbursement rate for CPT code 49621.
Additionally, it is essential to verify coverage and any local coverage determinations (LCDs) with the respective Medicare Administrative Contractor (MAC) for your region, as MACs can have varying guidelines and policies that may affect reimbursement.
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