CPT code 58542 is for a laparoscopic procedure to remove the uterus, weighing 250g or less, along with one or both fallopian tubes or ovaries.
CPT code 58542 is used to describe a specific surgical procedure known as a laparoscopic supracervical hysterectomy. This procedure involves the removal of the uterus while leaving the cervix intact, and it is performed using minimally invasive laparoscopic techniques. The code specifically applies when the uterus being removed weighs 250 grams or less. Additionally, this code includes the removal of one or both fallopian tubes and/or ovaries if necessary during the procedure. This code is essential for healthcare providers to accurately document and bill for the surgical services provided, ensuring proper reimbursement and record-keeping.
For CPT code 58542, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): 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): 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): Utilized 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 by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used when a related procedure is performed 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 modifiers are used to specify the side of the body on which the procedure was performed, particularly relevant if the procedure involves unilateral structures like ovaries.
7. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required for the procedure.
Each modifier should be used in accordance with payer policies and supported by appropriate documentation to ensure accurate billing and reimbursement.
CPT code 58542 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 by Medicare, including surgical procedures like those represented by CPT code 58542. The reimbursement amount can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. Each MAC may have different local coverage determinations (LCDs) that can affect whether and how a particular service is reimbursed. Therefore, healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 58542.
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