CPT code 58290 is used for a vaginal hysterectomy procedure involving the removal of a uterus weighing more than 250 grams.
CPT code 58290 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for the removal of a uterus that weighs more than 250 grams. 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 being greater than 250 grams is important as it indicates a more complex procedure due to the size of the uterus, which may require additional surgical expertise and resources. This code helps ensure accurate billing and reimbursement for the healthcare provider performing the surgery.
For CPT code 58290, which pertains to a vaginal hysterectomy for a uterus greater than 250 grams, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or difficulty of the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that multiple services were provided.
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: This is used when a procedure is 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider.
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 is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This is used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. It's important to use them appropriately to reflect the specific details of the surgical service provided.
The CPT code 58290 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, it's important to note that the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much a particular service, such as one billed under CPT code 58290, is reimbursed. Healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement rates for this code.
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