CPT code 58200 is for a total abdominal hysterectomy with partial vaginectomy and lymph node sampling, possibly including tube or ovary removal.
CPT code 58200 is used to describe a total abdominal hysterectomy procedure that includes the removal of the uterus through an incision in the abdomen. This procedure also involves a partial vaginectomy, which is the removal of part of the vaginal tissue. Additionally, it includes the sampling of lymph nodes from the para-aortic and pelvic regions to check for the spread of disease. The procedure may also involve the removal of one or both fallopian tubes and ovaries, depending on the patient's medical needs. This comprehensive surgical approach is typically employed in cases where there is a need to address conditions such as cancer or severe endometriosis.
For CPT code 58200, 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 additional work that was not anticipated.
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 discretion of the physician. This could occur if certain components of the procedure were not performed.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
8. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier when a minimum assistant surgeon is required for the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because 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 provider assists in the surgery.
These modifiers should be used in accordance with payer policies and specific clinical scenarios to ensure accurate billing and reimbursement.
The CPT code 58200 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 associated payment rates. However, the actual reimbursement for CPT code 58200 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and apply them to their specific jurisdiction, which can influence the reimbursement process for this particular code. Healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for CPT code 58200.
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