CPT code 49654 is a medical billing code for laparoscopic inguinal hernia repair, used to describe the procedure for insurance and record-keeping.
CPT code 49654 is used to describe a laparoscopic incision hernia repair. This procedure involves the surgical correction of a hernia using minimally invasive techniques, where small incisions are made in the abdomen. The surgeon utilizes a camera and specialized instruments to repair the hernia, which is a condition where an organ or tissue protrudes through an abnormal opening. This code specifically indicates that the repair is performed laparoscopically, which typically results in less postoperative pain and quicker recovery times compared to traditional open surgery.
For CPT code 49654 (Lap inc hernia repair), 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 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Applied when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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.
6. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Applied when a procedure or service is repeated by the same physician or other qualified healthcare professional.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Applied when a related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
15. 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 49654 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 these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement policies and rates for specific CPT codes within their jurisdictions. Therefore, it is advisable to consult the relevant MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 49654.
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