CPT code 58293 is for a vaginal hysterectomy of a large uterus, including a procedure to support the bladder and urethra, with or without endoscopic aid.
CPT code 58293 is used to describe a surgical procedure involving a vaginal hysterectomy for a uterus that weighs more than 250 grams. This procedure also includes a colpo-urethrocystopexy, which is a surgical technique to provide support to the bladder and urethra. The colpo-urethrocystopexy can be performed using the Marshall-Marchetti-Krantz type or the Pereyra type method, and it may be done with or without the use of endoscopic control. This code is specific to situations where both the removal of the uterus and the additional support procedure are performed together.
For CPT code 58293, the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
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 unexpected findings during surgery.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that more than one procedure was carried out and helps in the correct allocation of reimbursement.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the discretion of the physician. This might occur if the full procedure was not necessary or could not be completed.
4. 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure was repeated by the same provider on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is applicable if the procedure was repeated by a different provider on the same day.
7. 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.
8. 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.
9. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required due to the unavailability of a qualified resident.
11. 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 applied based on the specific circumstances of the procedure and in accordance with payer guidelines to ensure accurate billing and reimbursement.
The CPT code 58293 is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate and any associated guidelines.
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective payment rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide specific guidance on coverage policies, local coverage determinations, and any additional documentation requirements that may apply to CPT code 58293.
Always ensure that the service meets Medicare's medical necessity criteria and is billed in accordance with the latest coding and billing guidelines.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 58293. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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