CPT code 55831 is for a retropubic subtotal prostatectomy, covering procedures like vasectomy and urethral dilation during the surgery.
CPT code 55831 is used to describe a specific type of prostatectomy procedure. This code refers to a retropubic, subtotal prostatectomy, which involves the surgical removal of part of the prostate gland through an incision made in the lower abdomen, specifically behind the pubic bone. The procedure may also include additional tasks such as controlling postoperative bleeding, performing a vasectomy, conducting a meatotomy (an incision to widen the urethral opening), calibrating or dilating the urethra, and performing an internal urethrotomy (an incision within the urethra to relieve a stricture). This code is essential for healthcare providers to accurately document and bill for the comprehensive surgical services provided during this procedure.
For CPT code 55831, the following modifiers may be applicable depending on the specific circumstances of the procedure and the patient's condition:
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 more than one procedure was conducted.
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 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, this modifier indicates that each surgeon is performing a distinct part of the surgery.
7. Modifier 66 - Surgical Team: Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by a different physician.
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 applicable 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure correct usage.
The CPT code 55831 is reimbursed by Medicare, but the reimbursement is subject to several factors.
The Medicare Physician Fee Schedule (MPFS) determines the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 55831.
The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region.
Healthcare providers should consult the MPFS and their local MAC for the most accurate and up-to-date reimbursement information for CPT code 55831.
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