CPT code 55840 is for a retropubic radical prostatectomy, a surgical procedure to remove the prostate gland, possibly preserving nerves.
CPT code 55840 is used to describe a surgical procedure known as a retropubic radical prostatectomy. This procedure involves the removal of the prostate gland through an incision made in the lower abdomen, specifically behind the pubic bone. The term "radical" indicates that the surgery is extensive and aims to remove the prostate gland entirely, often including surrounding tissues and possibly nearby lymph nodes, to treat prostate cancer. The "with or without nerve sparing" part of the code signifies that during the procedure, the surgeon may attempt to preserve the nerves responsible for erectile function, depending on the patient's condition and the extent of cancer. This code is crucial for healthcare providers to accurately document and bill for the surgical services provided.
For CPT code 55840, the following modifiers may be applicable depending on the specific circumstances of the procedure and the patient's situation:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 (Multiple Procedures): If multiple procedures are performed during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 (Discontinued Procedure): This is 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 is used to indicate that both surgeons are primary surgeons.
7. Modifier 66 (Surgical Team): This is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician.
9. Modifier 77 (Repeat Procedure by Another Physician): This is used when the same 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 used when the patient returns 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): This is used when an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): This is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This is used when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier 99 (Multiple Modifiers): This is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with the specific circumstances of the procedure and the documentation should support the use of the modifier. Proper use of modifiers ensures accurate billing and reimbursement.
The CPT code 55840 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services and procedures covered by Medicare Part B, and CPT code 55840 is listed within this schedule. However, the reimbursement rate for this code can vary depending on the geographic location and specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your area. Each MAC has the authority to interpret national Medicare policies and set local coverage determinations, which can influence the reimbursement process. Therefore, it is essential for healthcare providers to verify the specific reimbursement details with their respective MAC to ensure accurate billing and payment.
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