CPT code 58280 is for a vaginal hysterectomy with total or partial vaginectomy, including the repair of an enterocele.
CPT code 58280 is used to describe a surgical procedure that involves a vaginal hysterectomy, which is the removal of the uterus through the vaginal canal. This procedure also includes a total or partial vaginectomy, which is the removal of all or part of the vaginal tissue. Additionally, the procedure involves the repair of an enterocele, which is a herniation of the small intestine into the vaginal area. This code is utilized by healthcare providers to accurately document and bill for this specific combination of surgical interventions, ensuring proper reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 58280, the following modifiers may be applicable depending on the specific circumstances of the procedure and the payer requirements:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. Documentation must support the substantial additional work.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this 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 is used when a 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: Apply this modifier when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required for the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
These modifiers should be used in accordance with payer guidelines and supported by appropriate documentation in the patient's medical record. Always verify with specific payer policies as they may have unique requirements or restrictions regarding modifier usage.
The CPT code 58280 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary.
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 depending on the region, as they are managed by the respective Medicare Administrative Contractor (MAC) responsible for processing claims in that area.
Healthcare providers should consult the MPFS and their local MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 58280.
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