CPT code 58544 is for a laparoscopic procedure involving the removal of a uterus over 250g, including tubes and/or ovaries, through a supracervical hysterectomy.
CPT code 58544 is used to describe a laparoscopic surgical procedure known as a supracervical hysterectomy. This specific code applies when the surgery involves the removal of the uterus that weighs more than 250 grams. Additionally, this procedure includes the removal of one or both fallopian tubes and/or ovaries. This code is crucial for healthcare providers to accurately document and bill for this complex surgical procedure, ensuring appropriate reimbursement and maintaining compliance with healthcare regulations.
For CPT code 58544, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 applicable when multiple procedures are performed during the same surgical session. It indicates that multiple procedures were performed and helps in the correct reimbursement of the services.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the procedure was not performed in its entirety.
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 used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
5. 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 returns to the operating room for a related procedure during the postoperative period of the initial surgery.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
7. 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.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
9. 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.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer requirements. Proper documentation is essential to support the use of any modifier.
The CPT code 58544 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 58544. To determine if this specific code is reimbursed, healthcare providers should consult the MPFS to verify if it is listed and to understand the associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect whether a particular service is reimbursed. Providers should check with their respective MAC to confirm any specific coverage policies or requirements related to CPT code 58544. This ensures compliance with both national and local Medicare guidelines, facilitating accurate and timely reimbursement.
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