CPT code 49905 is for an omental flap procedure performed within the abdomen, used in various surgical treatments.
CPT code 49905 is used to describe the surgical procedure involving the creation of an omental flap within the abdominal cavity. This procedure typically involves mobilizing a portion of the omentum, which is a fold of peritoneum extending from the stomach, to provide coverage or support to an area in need of repair or reconstruction. It is often utilized in cases where there is a need to enhance healing or to protect underlying structures following surgery or injury.
For CPT code 49905, which pertains to an omental flap intra-abdominal procedure, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates 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. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure. This is typically used for highly complex procedures that require multiple surgeons with different specialties.
6. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when the same physician needs to repeat the procedure on the same day. It indicates that the procedure was repeated due to medical necessity.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when a procedure is repeated by a different physician on the same day. It signifies that the repeat procedure was necessary and performed by another 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 when the patient requires an unplanned return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial 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 provides minimal assistance to the primary surgeon during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists 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 49905 is reimbursable by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) and local coverage determinations. Providers should consult their regional MAC for specific coverage and payment guidelines related to CPT 49905.
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