CPT code 49186 is for the surgical removal or destruction of intra-abdominal tumors or cysts measuring 5.1 to 10 cm in length.
CPT code 49186 is used to describe a surgical procedure involving the excision or destruction of a primary or secondary tumor or cyst located within the intra-abdominal area, such as the peritoneal, mesenteric, or retroperitoneal regions. This specific code applies when the sum of the maximum length of the tumor(s) or cyst(s) being removed or destroyed measures between 5.1 to 10 centimeters. This code is crucial for accurately documenting and billing for the surgical removal of tumors or cysts of this size within the specified intra-abdominal locations.
For CPT code 49186, 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. Documentation must support the substantial additional work and the reason for the additional work, such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
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. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work by appending modifier 62 to the procedure code and any associated add-on codes for that procedure.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the skills of several surgeons, often of different specialties, working together as a team. Each team member reports the same CPT code with modifier 66.
6. 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 a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
These modifiers help provide additional information to payers about the circumstances of the procedure, which can affect reimbursement and claims processing. Proper use of modifiers ensures accurate billing and reduces the likelihood of claim denials.
The CPT code 49186 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC may have specific guidelines or local coverage determinations (LCDs) that influence whether a particular service, such as that described by CPT code 49186, is reimbursed.
It is crucial for healthcare providers to verify the reimbursement status of CPT code 49186 with their respective MAC to ensure compliance with Medicare's billing requirements and to understand any documentation or medical necessity criteria that may apply.
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