CPT code 58285 is for a radical vaginal hysterectomy, known as the Schauta type operation, used in healthcare procedures documentation.
CPT code 58285 is used to describe a radical vaginal hysterectomy, specifically the Schauta type operation. This procedure involves the surgical removal of the uterus through the vaginal canal, and it is termed "radical" because it includes the removal of additional surrounding tissues, such as the cervix, part of the vagina, and possibly nearby lymph nodes, to treat certain gynecological cancers or severe conditions. The Schauta operation is a specific technique within this category, emphasizing a more extensive approach to ensure comprehensive treatment of the affected area.
For CPT code 58285, which pertains to a vaginal hysterectomy, radical (Schauta type operation), 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: If multiple procedures are performed during the same surgical session, this modifier indicates that multiple procedures were performed. It helps in the correct reimbursement of the primary and secondary procedures.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the procedure was not performed in its entirety.
4. Modifier 53 - Discontinued Procedure: This modifier is applicable if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, each surgeon should report the procedure with this modifier. It indicates that both surgeons are performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity. It indicates that the procedure necessitated a team approach.
8. 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 physician or healthcare professional.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different physician or healthcare professional.
10. 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 a patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
These modifiers help in accurately describing the circumstances under which the procedure was performed, ensuring appropriate billing and reimbursement. Always ensure that documentation supports the use of any modifier applied.
CPT code 58285, which refers to a specific surgical procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether this code is reimbursed and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and it is updated annually to reflect changes in policy and practice.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations in their respective jurisdictions. Each MAC may have specific local coverage determinations (LCDs) that influence whether a particular CPT code, such as 58285, is reimbursed. These LCDs can vary based on regional medical necessity and other criteria.
Therefore, while CPT code 58285 is generally reimbursable under Medicare, healthcare providers should verify the specific reimbursement details with their local MAC and consult the current MPFS to ensure compliance with Medicare's billing requirements.
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