CPT code 58210 is for a radical abdominal hysterectomy, including lymph node sampling and possibly removing tubes or ovaries.
CPT code 58210 is used to describe a surgical procedure known as a radical abdominal hysterectomy. This procedure involves the removal of the uterus through an incision in the abdomen. Additionally, it includes a bilateral total pelvic lymphadenectomy, which is the removal of lymph nodes from both sides of the pelvis, and para-aortic lymph node sampling or biopsy, which involves taking samples from the lymph nodes near the aorta for examination. The procedure may also involve the removal of one or both fallopian tubes and ovaries, depending on the patient's condition and the surgeon's assessment. This code is typically used in cases where a more extensive surgical approach is necessary, often due to cancer or other serious gynecological conditions.
For CPT code 58210, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work involved in the surgery.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was performed and helps in the appropriate allocation of reimbursement.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly relevant if additional procedures are performed that are not typically bundled with the primary procedure.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by appending this modifier.
5. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: Used if the same procedure needs to be repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Applied when a procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 58210 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) determines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 58210. The reimbursement amount can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining coverage specifics for CPT codes. They ensure that the services billed are medically necessary and meet Medicare's coverage criteria. Therefore, while CPT code 58210 is generally reimbursable, healthcare providers should verify the specific coverage details and reimbursement rates with their local MAC to ensure compliance and accurate billing.
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