CPT code 58292 is for a vaginal hysterectomy of a uterus over 250g, including tube/ovary removal and enterocele repair.
CPT code 58292 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for cases where the uterus weighs more than 250 grams. This procedure involves the removal of the uterus through the vaginal canal. Additionally, this code indicates that during the surgery, one or both of the fallopian tubes and/or ovaries are also removed. Furthermore, the procedure includes the repair of an enterocele, which is a herniation of the small intestine into the vaginal wall. This comprehensive code is utilized by healthcare providers to accurately document and bill for this specific combination of surgical interventions.
For CPT code 58292, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. Modifier 59 - Distinct Procedural Service: Apply this modifier when a procedure or service was distinct or independent from other services performed on the same day. This could be necessary if the hysterectomy was performed in conjunction with other unrelated procedures.
4. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if the procedure was repeated by a different physician on the same day.
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: Use this modifier if the patient had to return 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 58292 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 represented by CPT code 58292.
The reimbursement amount can vary based on geographic location, 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 with their local MAC to ensure accurate billing and optimal reimbursement for services rendered under CPT code 58292.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 58292, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and safeguard your practice's financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
