CPT code 58267 is for a vaginal hysterectomy with additional procedures for bladder support, applicable to a uterus weighing 250 grams or less.
CPT code 58267 is used to describe a surgical procedure involving a vaginal hysterectomy for a uterus weighing 250 grams or less. This procedure also includes a colpo-urethrocystopexy, which is a surgical technique to support the bladder and urethra, often performed to address urinary incontinence. The colpo-urethrocystopexy can be done using the Marshall-Marchetti-Krantz type or the Pereyra type method, and it may be performed with or without the use of endoscopic control to assist in the visualization and precision of the surgery. This code is specific to healthcare providers who perform these combined procedures and is used for billing and documentation purposes in the healthcare revenue cycle.
For CPT code 58267, the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual circumstances or complications during the surgery.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out, which may affect reimbursement.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This might occur if the full extent of the procedure was not necessary.
4. 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 helps to clarify that the procedures are not duplicates.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is repeated by the same physician on the same day. This indicates that the procedure was necessary to be performed again.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It helps to differentiate between the providers involved.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Apply this modifier when an assistant surgeon is required for the procedure. This indicates that another surgeon assisted in the operation.
10. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimal assistant surgeon is required for the procedure, indicating limited assistance was provided.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances of the procedure, which can be crucial for accurate billing and reimbursement. Always ensure that the use of modifiers is supported by proper documentation in the patient's medical record.
The CPT code 58267 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates.
Additionally, reimbursement for CPT code 58267 may vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, healthcare providers should consult their respective MAC for precise information on reimbursement rates and any specific billing requirements related to CPT code 58267.
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