CPT code 49651 is for laparoscopic inguinal hernia repair, specifically for recurrent cases, detailing the procedure for billing and documentation.
CPT code 49651 is for a laparoscopic inguinal hernia repair that is performed on a recurrent hernia. This procedure involves using minimally invasive techniques to surgically correct a hernia that has returned after a previous repair. The laparoscopic approach typically results in less postoperative pain and quicker recovery times compared to traditional open surgery.
For CPT code 49651, which pertains to laparoscopic inguinal hernia repair for a recurrent hernia, 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.
2. Modifier 50 - Bilateral Procedure: Used 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.
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 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 49651 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the respective Medicare Administrative Contractor (MAC) for any local coverage determinations or specific guidelines that may affect reimbursement for CPT code 49651.
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 49651. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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