CPT code 49906 is for a free omental flap microvascular procedure, used in reconstructive surgery to enhance healing and tissue coverage.
CPT code 49906 is used to describe the surgical procedure involving the free omental flap, which is a type of tissue transfer. This procedure typically involves the mobilization of the omentum, a fold of peritoneum extending from the stomach, to be used as a flap for reconstructive purposes. The microvascular aspect indicates that the flap is transferred with the use of microsurgical techniques, allowing for the connection of blood vessels to ensure proper blood supply to the transplanted tissue. This code is relevant for healthcare providers performing complex reconstructive surgeries, particularly in cases where tissue coverage is needed for wound healing or defect repair.
For CPT code 49906 (Free omental flap microvasc), 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 50 - Bilateral Procedure: Indicates that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 66 - Surgical Team: Indicates that a surgical team was required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
10. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service is repeated by another physician or other qualified healthcare professional.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician 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.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
15. 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.
16. 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.
The CPT code 49906, "Free omental flap microvasc," is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on whether a specific CPT code is covered and the associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the coverage and payment policies for CPT codes within their respective jurisdictions. Therefore, healthcare providers should consult both the MPFS and their local MAC to confirm the reimbursement status and any specific billing requirements for CPT code 49906.
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