CPT code 58240 is for a complex surgery involving removal of pelvic organs due to gynecologic cancer, including hysterectomy and possible colostomy.
CPT code 58240 is a comprehensive surgical procedure primarily used in the treatment of gynecologic malignancies. This code represents a pelvic exenteration, which is an extensive operation involving the removal of various organs and tissues within the pelvic cavity. Specifically, it includes a total abdominal hysterectomy or cervicectomy, which involves the removal of the uterus and cervix. Additionally, the procedure may involve the removal of one or both fallopian tubes and ovaries, depending on the patient's condition and the extent of the malignancy.Moreover, this procedure includes the removal of the bladder, necessitating ureteral transplantations to reroute urine flow. It may also involve an abdominoperineal resection of the rectum and colon, which requires the creation of a colostomy to allow waste to exit the body. The complexity and scope of this surgery make it a significant intervention aimed at addressing advanced or recurrent gynecologic cancers, providing a chance for disease control when other treatments may not be viable.
For CPT code 58240, 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. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are primary and each performs a distinct part of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used 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 because a qualified resident surgeon is not available.
These modifiers should be applied based on the specific details and circumstances of the procedure performed. Proper documentation is essential to justify the use of any modifier.
The CPT code 58240 is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate and any associated guidelines.
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective payment rates, which are updated annually.
Additionally, the reimbursement for CPT code 58240 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations.
Therefore, healthcare providers should consult their specific MAC for detailed information on coverage policies and any potential variations in reimbursement for this procedure.
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