CPT code 58270 is used for a vaginal hysterectomy procedure involving the removal of a uterus weighing 250 grams or less, including enterocele repair.
CPT code 58270 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for a uterus that weighs 250 grams or less. This procedure also includes the repair of an enterocele, which is a type of pelvic organ prolapse where the small intestine descends into the lower pelvic cavity, often causing discomfort or other symptoms. This code is utilized by healthcare providers to accurately document and bill for the comprehensive surgical service provided, ensuring proper reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 58270, which involves a vaginal hysterectomy with repair of enterocele, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work 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 is used to indicate that more than one procedure was performed.
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. It is particularly useful when procedures are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if the same procedure is repeated by the same provider.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the procedure is repeated by a different provider.
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 if the patient needs to return 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 provider during the postoperative period of the initial procedure.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 58270 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary.
Reimbursement rates for this code can be found in the Medicare Physician Fee Schedule (MPFS), which outlines the payment amounts for services covered under Medicare Part B.
It's important to note that the reimbursement may vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC).
The MAC is responsible for processing claims and ensuring compliance with Medicare policies in their respective jurisdictions.
Healthcare providers should verify the specific reimbursement details and any additional requirements with their local MAC to ensure proper billing and payment for CPT code 58270.
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