CPT code 49657 is a medical billing code for laparoscopic repair of a recurrent inguinal hernia with complications.
CPT code 49657 is used to describe a laparoscopic incision for the repair of a recurrent complex hernia. This procedure involves minimally invasive techniques to address a hernia that has reappeared after previous surgical intervention, focusing on the intricate nature of the hernia repair.
For CPT code 49657, which pertains to laparoscopic incisional hernia repair for a recurrent, complex case, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. For example, if the recurrent hernia repair is more complex due to extensive adhesions or previous surgical complications, Modifier 22 would be appropriate.
2. Modifier 51 (Multiple Procedures): If multiple procedures are performed during the same surgical session, Modifier 51 should be appended to indicate that more than one procedure was performed.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. For instance, if another unrelated laparoscopic procedure is performed during the same session, Modifier 59 would be used.
4. Modifier 62 (Two Surgeons): When two surgeons work together as primary surgeons performing distinct parts of the procedure, Modifier 62 should be used to indicate the collaborative effort.
5. Modifier 66 (Surgical Team): If the procedure requires a surgical team due to its complexity, Modifier 66 should be appended to indicate that multiple professionals were involved in the surgery.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to repeat the procedure on the same day, Modifier 76 would be used to indicate the repeat service.
7. Modifier 77 (Repeat Procedure by Another Physician): If a different physician repeats the procedure on the same day, Modifier 77 should be used.
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 needs 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): If an unrelated procedure is performed by the same physician during the postoperative period, Modifier 79 should be used.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, Modifier 80 should be appended to indicate the involvement of an assistant.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): If an assistant surgeon is required and a qualified resident surgeon is not available, Modifier 82 should be used.
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 49657, which refers to a specific medical procedure, is subject to reimbursement by Medicare. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is crucial to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 49657.
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