CPT code 51925 is for the surgical procedure involving the closure of a vesicouterine fistula, performed alongside a hysterectomy.
CPT code 51925 is used to describe the surgical procedure for the closure of a vesicouterine fistula, which is an abnormal connection between the bladder and the uterus. This specific code also includes the performance of a hysterectomy, which is the surgical removal of the uterus. This procedure is typically necessary to correct complications that may arise from the fistula, such as recurrent urinary tract infections or urinary incontinence, and to prevent further health issues. The inclusion of a hysterectomy indicates that the procedure is more extensive, addressing both the fistula and the removal of the uterus in a single surgical session.
For CPT code 51925, which involves the closure of a vesicouterine fistula with hysterectomy, 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 factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the discretion of the physician.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved.
7. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier is used to indicate the involvement of multiple professionals.
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 needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help perform the procedure, this modifier is used to indicate their involvement.
10. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.
11. 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 surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 51925, which involves the closure of a vesicouterine fistula with hysterectomy, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 51925 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations regarding coverage and payment for specific services within their jurisdictions. Therefore, it is essential for healthcare providers to check with their respective MAC to confirm if CPT code 51925 is covered and to understand any specific billing guidelines or documentation requirements that may apply.
In summary, while CPT code 51925 can be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for precise coverage details and reimbursement policies.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 51925, and by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
