CPT code 55867 is for a laparoscopic surgical prostatectomy, covering various procedures and may include robotic assistance.
CPT code 55867 is used to describe a laparoscopic surgical procedure for a simple subtotal prostatectomy. This procedure involves the partial removal of the prostate gland using minimally invasive techniques. The code also covers additional procedures that may be performed during the surgery, 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 to relieve urethral stricture). Furthermore, this code includes the use of robotic assistance if it is utilized during the procedure. This comprehensive coding ensures that all aspects of the surgical intervention are accounted for in the billing process.
For CPT code 55867, 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 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): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
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. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure, each surgeon should report the procedure with this modifier. Each surgeon must document their specific role in the surgery.
7. Modifier 66 (Surgical Team): Use this modifier when a team of surgeons is required to perform the procedure. Documentation should support the necessity of a team approach.
8. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure. The assistant surgeon should report the procedure with this modifier.
9. Modifier 81 (Minimum Assistant Surgeon): Use this modifier when an assistant surgeon is required on a minimal basis.
10. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. Modifier 99 (Multiple Modifiers): If multiple modifiers are applicable, this modifier indicates that more than one modifier is being used. Documentation should clearly outline the use of each modifier.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Proper documentation is crucial when applying any modifier to support its use.
CPT code 55867 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 55867 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and making coverage determinations within their jurisdiction, so it's important for healthcare providers to verify the specific reimbursement details and any additional requirements with their respective MAC.
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