CPT CODES

CPT Code 49187

CPT code 49187 is for the surgical removal or destruction of intra-abdominal tumors or cysts measuring 10.1 to 20 cm in length.

Table of Contents
What is CPT Code 49187
Does CPT 49187 Need a Modifier?
CPT Code 49187 Medicare Reimbursement
Are You Being Underpaid for 49187 CPT Code?
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What is CPT Code 49187

CPT code 49187 is used to describe a surgical procedure involving the excision or destruction of tumors or cysts 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 10.1 to 20 centimeters. This code is crucial for accurately documenting and billing for the complexity and extent of the surgical intervention performed on primary or secondary tumors or cysts within these specified abdominal regions.

Does CPT 49187 Need a Modifier?

For CPT code 49187, 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. This could be due to unusual pathology, anatomical variations, or other complicating factors.

2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.

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 that are not normally reported together but are appropriate under the circumstances.

4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate their collaborative effort.

5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team.

6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.

7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different 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 a patient requires a return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.

10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.

11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon provides minimal assistance during the procedure.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.

These modifiers help provide additional information about the circumstances under which the procedure was performed, which can be crucial for accurate billing and reimbursement.

CPT Code 49187 Medicare Reimbursement

CPT code 49187 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 guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of fees that Medicare will pay for each service, and it is updated annually to reflect changes in medical practice and economic conditions.

To determine if CPT code 49187 is reimbursed, healthcare providers should consult the MPFS to see if the code is listed and what the associated reimbursement rate is. Additionally, it is crucial to check with the local MAC, as they have the authority to make determinations on coverage and payment policies, which can vary by region. The MAC may also provide specific guidance on documentation requirements or any additional criteria that must be met for reimbursement. Therefore, while CPT code 49187 can be reimbursed by Medicare, verification through these channels is essential to ensure compliance and proper payment.

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