CPT code 58291 is for a vaginal hysterectomy procedure involving the removal of a uterus over 250 g, including tubes and/or ovaries.
CPT code 58291 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for cases where the uterus weighs more than 250 grams. This code also indicates that during the procedure, one or both of the fallopian tubes and/or ovaries are removed. This type of surgery is typically performed to treat various gynecological conditions such as fibroids, endometriosis, or cancer, and the removal of additional reproductive organs may be necessary depending on the patient's medical needs. The use of this specific CPT code helps ensure accurate billing and documentation for the healthcare provider performing the surgery.
For CPT code 58291, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the surgery.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Used 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 78 (Unplanned Return to the Operating/Procedure Room): Used when a patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
5. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
6. Modifier LT (Left Side) and RT (Right Side): These are used to specify the side of the body on which the procedure was performed, particularly relevant if the procedure involves unilateral removal of tubes or ovaries.
7. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used when an evaluation and management service is performed during the postoperative period for a reason unrelated to the original procedure.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. It's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 58291 is reimbursed by Medicare, but the reimbursement is subject to several factors.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 58291.
The reimbursement amount can vary based on geographic location and other considerations, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region.
Each MAC may have slightly different interpretations and guidelines, so it's essential for healthcare providers to verify the specific reimbursement details and any local coverage determinations that might apply to CPT code 58291 in their area.
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