CPT code 55845 is for a retropubic radical prostatectomy, possibly nerve-sparing, with bilateral pelvic lymphadenectomy, covering specific lymph nodes.
CPT code 55845 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. The surgery may or may not include nerve-sparing techniques, which aim to preserve the nerves responsible for erectile function. Additionally, this code covers the removal of lymph nodes from both sides of the pelvis, specifically targeting the external iliac, hypogastric, and obturator nodes. This comprehensive approach is often employed in the treatment of prostate cancer to ensure the thorough removal of cancerous tissues and to assess the spread of cancer to the lymph nodes.
For CPT code 55845, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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, each surgeon should report their distinct operative work using this modifier.
7. Modifier 66 (Surgical Team): Use this modifier when a complex procedure requires a surgical team.
8. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier when an assistant surgeon is required on a less than full-time basis.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
11. Modifier 99 (Multiple Modifiers): If more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are applicable.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as they may have unique requirements for modifier usage.
The CPT code 55845 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually to reflect changes in medical practice and the economy.
However, the reimbursement for CPT code 55845 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing Medicare claims and setting specific payment rates within their jurisdiction, ensuring that the reimbursement aligns with regional cost variations and other local considerations.
Therefore, healthcare providers should consult their specific MAC for precise reimbursement details related to CPT code 55845.
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