CPT code 58152 is for a total abdominal hysterectomy with colpo-urethrocystopexy, possibly including removal of tubes or ovaries.
CPT code 58152 is used to describe a surgical procedure known as a total abdominal hysterectomy, which involves the removal of the uterus and cervix. This procedure may also include the removal of one or both fallopian tubes and ovaries, depending on the patient's medical needs. Additionally, this code specifies that the surgery includes a colpo-urethrocystopexy, a technique used to provide support to the bladder and urethra, often to address issues such as urinary incontinence. The colpo-urethrocystopexy can be performed using methods like the Marshall-Marchetti-Krantz or Burch procedures. This comprehensive code is essential for accurately documenting and billing for this complex surgical intervention in the healthcare revenue cycle.
For CPT code 58152, 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 other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. 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 may be necessary if the hysterectomy was performed in conjunction with other unrelated procedures.
4. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier is used to indicate the repetition.
5. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate that the repeat procedure was necessary.
6. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. 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 of the initial surgery.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier indicates their involvement.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but specifically used when a qualified resident surgeon is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier should be used in accordance with payer guidelines and documentation must support the use of any modifier to ensure proper reimbursement.
The CPT code 58152 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, the specific reimbursement and coverage details can vary depending on the region, as they are also influenced by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to establish local coverage determinations (LCDs) that may affect the reimbursement process for CPT code 58152. Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to ensure compliance and proper reimbursement for this procedure.
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