tci General Surgery Coding Alert - 2008 Issue 10

Reader Questions: Weight, Not Age, Determines 63 Applicability

Question: The surgeon performed an initial repair for a reducible inguinal hernia on a preterm infant. Should I append modifier 63 to 49491 due to the patient's young age? Nevada Subscriber Answer: No, you should not append modifier 63 (Procedure performed on infants) to hernia repair code 49491 (Repair, initial inguinal hernia, preterm infant [younger than 37 weeks gestation at birth], performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible).Here's why: Numerous CPT codes already reflect additional physician work for tending to a small patient. Appending modifier 63 in these cases would constitute...

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