CPT code 49623 is for the removal of an infected mesh used in hernia repair surgery.
CPT code 49623 is used to describe the surgical procedure for the removal of an infected mesh used in a hernia repair. This code specifically indicates that the procedure involves the excision of the mesh material that has become infected, which may be necessary to address complications arising from a previous hernia repair surgery.
For CPT code 49623, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if 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 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.
3. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure needs to be repeated by the same provider due to medical necessity.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the procedure is repeated by a different provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier when a minimum assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician providers assist in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 49623, which pertains to the removal of non-infected mesh during hernia repair, is reimbursed by Medicare. Reimbursement for this code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring that the services billed under CPT code 49623 meet the necessary coverage criteria. Providers should consult the MPFS and their respective MAC for specific reimbursement rates and guidelines.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 49623. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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