CPT code 49999 is an unlisted procedure code for abdominal and peritoneal surgeries, used when no specific code exists for the service provided.
CPT code 49999 is an unlisted procedure code for abdominal, peritoneal, and omental surgeries. This code is used when a specific procedure does not have a designated CPT code, allowing healthcare providers to report a unique surgical intervention that may not fit into existing categories. It is essential for documentation and billing purposes, as it provides a way to capture and communicate the details of the procedure performed.
For CPT code 49999, which is an unlisted procedure code for the abdomen, peritoneum, and omentum, 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 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Indicates that a procedure or service is repeated by a different provider.
7. 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 patient returns to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for the procedure.
11. 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.
12. Modifier 99 - Multiple Modifiers: Indicates that multiple modifiers are applicable to the procedure.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 49999 is not directly reimbursed by Medicare. As an unlisted procedure code, it does not have a set reimbursement rate in the Medicare Physician Fee Schedule (MPFS). When billing this code, providers must submit additional documentation to their Medicare Administrative Contractor (MAC) for manual review and pricing determination.
The MAC will evaluate the documentation and assign a payment amount based on a comparable procedure code or resource utilization. Reimbursement for CPT 49999 is not guaranteed and may vary depending on the specific circumstances and the MAC's decision.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments with precision, down to the CPT code level and by individual payer. Imagine the impact of identifying discrepancies for CPT code 49999 and ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
