CPT code 55810 is for a perineal radical prostatectomy, a surgical procedure to remove the prostate gland through an incision in the perineum.
CPT code 55810 is used to describe a perineal radical prostatectomy, which is a surgical procedure involving the removal of the prostate gland through an incision made in the perineum, the area between the scrotum and the anus. This procedure is typically performed to treat prostate cancer and involves the complete removal of the prostate gland along with some surrounding tissue, potentially including nearby lymph nodes, to ensure that cancerous cells are thoroughly excised. The perineal approach is one of several surgical techniques available for prostatectomy, chosen based on the patient's specific medical condition and the surgeon's expertise.
For CPT code 55810, which involves a prostatectomy, perineal radical, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unexpected findings during surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the prostatectomy was one of several procedures.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was 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 the prostatectomy was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: If two surgeons were required to perform distinct parts of the procedure, this modifier should be used.
7. Modifier 66 - Surgical Team: Use this modifier when a team of surgeons is necessary to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier is applicable.
9. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure, this modifier should be used.
10. 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.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be applied.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
14. 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.
15. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary, this modifier indicates that multiple modifiers are being used.
Each modifier serves a specific purpose and should be applied based on the circumstances surrounding the procedure to ensure accurate billing and reimbursement.
CPT code 55810 is reimbursed by Medicare, but the reimbursement specifics depend on several factors, including the Medicare Physician Fee Schedule (MPFS) and the regional policies set by the Medicare Administrative Contractor (MAC) for your area.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis.
Each MAC may have different guidelines and reimbursement rates for CPT code 55810, so it is essential to verify with your local MAC to understand the exact reimbursement details and any specific documentation requirements that may apply.
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 55810, and by individual payer. Don't let hidden discrepancies impact your revenue. Schedule a demo today to see how RevFind can enhance your financial accuracy and boost your bottom line.
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
