CPT code 49190 is for the surgical removal or destruction of small intra-abdominal tumors, cysts, or endometriomas, measuring 5 cm or less.
CPT code 49190 is used to describe a surgical procedure involving the excision or destruction of intra-abdominal tumors, cysts, or endometriomas. This procedure is performed through an open surgical approach and targets one or more primary or secondary tumors located in the peritoneal, mesenteric, or retroperitoneal areas. The specific focus of this code is on the removal or destruction of the largest tumor that measures 5 centimeters in diameter or less. This code is essential for accurately documenting and billing for the surgical management of smaller intra-abdominal tumors within the specified regions.
For CPT code 49190, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or time.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was conducted.
3. Modifier 59 (Distinct Procedural Service): Utilized to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
5. Modifier 66 (Surgical Team): Applied when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician 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): Used when a related procedure is performed during the postoperative period of the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
The CPT code 49190 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 of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the actual reimbursement for CPT code 49190 can vary based on the geographic location and specific guidelines set forth by the MAC responsible for that region.
It is essential for healthcare providers to verify the specific coverage details and reimbursement rates with their local MAC to ensure compliance and accurate billing.
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