CPT code 58294 is for a vaginal hysterectomy of a uterus over 250 g, including the repair of an enterocele.
CPT code 58294 is used to describe a surgical procedure involving a vaginal hysterectomy for a uterus that weighs more than 250 grams. This procedure also includes the repair of an enterocele, which is a herniation of the small intestine into the vaginal wall. This code is specifically utilized by healthcare providers to document and bill for this comprehensive surgical intervention, ensuring accurate communication and reimbursement within the healthcare revenue cycle.
For CPT code 58294, the following modifiers may be applicable depending on the specific circumstances of the procedure and the payer requirements:
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: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. 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.
4. 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 provider. It indicates that the procedure was repeated for a valid reason.
5. 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 provider. It indicates that the procedure was repeated for a valid reason.
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: This modifier is used when a patient requires a 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 a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
10. 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 used in accordance with payer guidelines and specific clinical scenarios to ensure accurate billing and reimbursement. Proper documentation is crucial to support the use of any modifier.
The CPT code 58294 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) is the primary tool used to determine the reimbursement rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 58294. The MPFS outlines the payment amounts for each service, which are updated annually.
However, the actual reimbursement can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. MACs have the authority to make local coverage determinations (LCDs) that can affect whether a particular service is covered and under what circumstances. Therefore, while CPT code 58294 is generally reimbursable under Medicare, healthcare providers should verify the specific coverage details and reimbursement rates with their local MAC to ensure compliance and accurate billing.
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 58294, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance your revenue cycle management.
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
