CPT code 49659 is for an unlisted laparoscopic procedure related to hernia repair, used when no specific code exists for the service provided.
CPT code 49659 is used to describe an unlisted laparoscopic procedure related to the hernia repair. This code is applied when a specific laparoscopic hernia repair procedure does not have a designated code in the Current Procedural Terminology (CPT) system. It allows healthcare providers to report a unique surgical intervention that may not fit into existing categories, ensuring proper documentation and billing for the services rendered.
For CPT code 49659 (Unlisted laparoscopy procedure, hernia repair), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: When a team of surgeons is required to perform a specific procedure.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Indicates that a procedure or service was repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: When an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: When a minimum assistant surgeon is required during the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 49659 is not typically reimbursed by Medicare. This code is not listed on the Medicare Physician Fee Schedule (MPFS), which means it does not have an assigned relative value unit (RVU) or payment rate. Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific guidance on billing and reimbursement policies for this unlisted procedure code. In most cases, MACs require additional documentation and may review claims with unlisted codes on a case-by-case basis to determine coverage and payment.
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