CPT code 58275 is used for a vaginal hysterectomy procedure for a uterus weighing 250 grams or less, aiding in standardized medical procedure documentation.
CPT code 58275 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for the removal of a uterus that weighs 250 grams or less. This code is utilized by healthcare providers to document and bill for this particular type of hysterectomy, which involves the removal of the uterus through the vaginal canal. The specification of the uterus weighing 250 grams or less is important for accurate coding and billing, as it distinguishes this procedure from other types of hysterectomies that may involve different surgical techniques or larger uterine sizes.
For CPT code 58275, 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: This is used when a patient returns 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: This indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when these non-physician practitioners assist in surgery.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer requirements. Proper documentation is essential to justify the use of any modifier.
CPT code 58275 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, the specific reimbursement and coverage details can vary based on the region, as they are managed by the respective Medicare Administrative Contractor (MAC) for that area. It is essential for healthcare providers to verify the local MAC guidelines and ensure that all documentation and coding requirements are met to facilitate proper reimbursement for CPT code 58275.
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