CPT code 49653 is for a laparoscopic ventral or abdominal hernia repair procedure that involves complex techniques.
CPT code 49653 is used to describe a laparoscopic ventral or abdominal hernia repair procedure that is considered complex. This code indicates that the surgical approach involves minimally invasive techniques to address a hernia located in the abdominal wall, which may require additional resources or specialized skills due to the complexity of the case.
When using CPT code 49653 for laparoscopic ventral or incisional hernia repair with implantation of mesh, 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 complications or other factors that increased the complexity of the surgery.
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: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful if the procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure, this modifier should be used to indicate that both surgeons had distinct roles and shared responsibility for 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 healthcare 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 on the same day. This helps in differentiating the repeated procedure from the initial one.
7. Modifier 77 - Repeat Procedure by Another Physician: If another physician had to repeat the procedure on the same day, this modifier should be used to indicate that the repeat procedure was performed by a different healthcare provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used 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: Apply this modifier if an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is 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: Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and helps in accurately representing the circumstances under which the procedure was performed, ensuring appropriate billing and reimbursement.
CPT code 49653 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as geographic location and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in your area. Providers should consult their local MAC for specific coverage and payment guidelines related to this procedure.
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