CPT code 49655 is for laparoscopic incisional hernia repair, a minimally invasive surgical procedure to fix a hernia.
CPT code 49655 is used to describe a laparoscopic incisional hernia repair that is complex in nature. This procedure involves the surgical correction of a hernia that has developed at the site of a previous surgical incision, utilizing minimally invasive techniques. The complexity indicates that the repair may involve additional challenges, such as the presence of scar tissue or other anatomical considerations, requiring a more intricate approach to ensure a successful outcome.
For CPT code 49655, which pertains to laparoscopic incisional hernia repair, 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 factors such as increased intensity, time, technical difficulty, or physical and mental effort.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. This helps in indicating that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
5. Modifier 66 - Surgical Team: This modifier is applicable when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician needs to repeat the procedure for the same patient on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier when a procedure is repeated by a different physician on the same day.
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 when a patient requires a 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: Apply this modifier when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is 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 provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 49655 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is essential to verify the fee schedule to determine the exact reimbursement amount for CPT code 49655.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. Therefore, it is advisable to consult the relevant MAC for your region to confirm the reimbursement details and any additional requirements for CPT code 49655.
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