CPT code 58543 is for a surgical procedure involving a laparoscopic supracervical hysterectomy for a uterus weighing more than 250 grams.
CPT code 58543 is used to describe a laparoscopic surgical procedure known as a supracervical hysterectomy, specifically for cases where the uterus being removed weighs more than 250 grams. In this procedure, the surgeon removes the upper part of the uterus while leaving the cervix intact, using minimally invasive techniques. This code is crucial for healthcare providers to accurately document and bill for the specific type of hysterectomy performed, ensuring appropriate reimbursement and maintaining precise medical records.
For CPT code 58543, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 should be used to indicate that more than one procedure was conducted.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: This modifier is used if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure, this modifier should be used to indicate the collaborative effort.
7. Modifier 66 - Surgical Team: Apply this modifier if the procedure required a surgical team due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician performed the procedure more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the procedure on the same day.
10. 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.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements.
CPT code 58543, which involves a specific surgical procedure, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the reimbursement rates for various CPT codes, including 58543. To determine if this code is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on whether CPT code 58543 is covered in specific regions or under particular circumstances. Coverage can vary based on local coverage determinations (LCDs) set by MACs, which may influence whether this procedure is reimbursed in certain areas or under specific conditions.
Therefore, while CPT code 58543 is generally reimbursable under Medicare, providers should verify its status on the MPFS and consult their regional MAC for any specific coverage criteria or limitations.
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