CPT code 58150 is for a total abdominal hysterectomy, including the removal of the uterus and cervix, with optional removal of tubes or ovaries.
CPT code 58150 is used to describe a surgical procedure known as a total abdominal hysterectomy. This procedure involves the removal of the uterus (corpus) and cervix through an incision in the abdomen. Additionally, this code covers the removal of one or both fallopian tubes and/or ovaries, although these removals are optional and not required for the use of this code. This comprehensive surgical approach is typically employed to treat various gynecological conditions, such as uterine fibroids, endometriosis, or cancer. The use of this CPT code ensures accurate billing and documentation for healthcare providers performing this specific procedure.
For CPT code 58150, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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: 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: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
4. 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 that are not normally reported together but are appropriate under the circumstances.
5. 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 a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure. Documentation should support the necessity of an assistant.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
Each modifier should be used with appropriate documentation to justify its application, ensuring compliance with payer policies and accurate reimbursement.
CPT code 58150 is reimbursed by Medicare, provided that the procedure is deemed medically necessary and meets all coverage criteria. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services rendered by physicians and other healthcare providers.
Additionally, the specific reimbursement amount and any additional coverage details may vary depending on the region, as they are influenced by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting regional policies, so it is essential for healthcare providers to verify the specifics with their respective MAC to ensure proper billing and reimbursement for CPT code 58150.
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