CPT code 49189 is for the surgical removal or destruction of large tumors or cysts in the abdominal area, measuring over 30 cm in total length.
CPT code 49189 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, which includes the peritoneal, mesenteric, or retroperitoneal regions. This code specifically applies when the sum of the maximum length of the tumor(s) or cyst(s) being removed or destroyed is greater than 30 centimeters. This procedure is typically performed in cases where large tumors or cysts need to be addressed to alleviate symptoms or prevent further complications.
For CPT code 49189, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more effort or time than typically required.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: This modifier is applicable if two surgeons were required to perform the procedure together, each performing distinct parts of the surgery.
5. Modifier 66 - Surgical Team: Use this modifier if the procedure required a surgical team due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician had to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician had to repeat the procedure on the same day.
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 if the patient had to 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: Use this modifier if the procedure was unrelated to the original surgery and occurred during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
These modifiers help provide additional context and specificity to the billing and documentation of the procedure, ensuring accurate reimbursement and compliance with coding guidelines. Always verify payer-specific requirements as they may vary.
The CPT code 49189 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries. Whether CPT code 49189 is reimbursed by Medicare depends on its inclusion in the MPFS and the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
Each MAC has the authority to interpret national Medicare policies and determine coverage and reimbursement for specific CPT codes based on local coverage determinations (LCDs). Therefore, it is essential to verify with your regional MAC to confirm if CPT code 49189 is reimbursed and to understand any specific documentation or billing requirements that may apply. Additionally, providers should ensure that the service meets all necessary medical necessity criteria as outlined by Medicare guidelines to secure reimbursement.
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