CPT code 58263 is for a vaginal hysterectomy for a uterus 250 g or less, including removal of tubes/ovaries and repair of an enterocele.
CPT code 58263 is used to describe a surgical procedure involving a vaginal hysterectomy for a uterus weighing 250 grams or less. This procedure includes the removal of one or both fallopian tubes and/or ovaries. Additionally, it involves the repair of an enterocele, which is a herniation of the small intestine into the vaginal wall. This code is utilized by healthcare providers to accurately document and bill for this specific combination of surgical services.
For CPT code 58263, 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 time and effort.
2. Modifier 51 - Multiple Procedures: If multiple procedures are 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.
4. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is applicable.
5. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician.
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 when the patient returns 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is applicable.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary due to the unavailability of a qualified resident.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies for precise application.
The CPT code 58263 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 58263. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific service is reimbursed in their jurisdiction. Therefore, while CPT code 58263 is generally reimbursable under Medicare, healthcare providers should verify the specific coverage and reimbursement details with their respective MAC to ensure compliance with any local policies or requirements.
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