What Modifier Is Appended to CPT Code 49905?

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October 17, 2013

Question:

The surgeon submitted CPT codes 44160 and 49905. We are using a code check program with our clearinghouse and it is telling us that Medicare considers these inclusive to each other. Can we report and if yes, what modifier? We have attended many courses with Mary LeGrand, who has been a fantastic help to our practice and I know we have billed this combination in the past, so we are unsure what is occurring.

Answer:

Thanks for your inquiry and your comments! I am not sure what program you are using but there are no CCI edits in place for this code combination. CPT code 44160 defines a partial colectomy with removal of terminal ileum and CPT code, 49905, an add-on code describes the omental flap. CPT code 49905 does not have a specific index or parent code, thus may be reported with any procedure code when performed. Since CPT code 49905 is an add-on code, you will just report 44160 and 49905. Please check with your clearinghouse or practice management vendor to determine the source of this edit in your system.

Here is a snapshot from the third quarter 2013 CCI Validator showing an edit does not exist.

CCI Validation Report

CityDateCityDate
Phoenix, AZSeptember 30 - October 1Chicago, ILNovember 11-12
Tinton Falls, NJOctober 14