CPT code 58548 is for a surgical laparoscopy involving radical hysterectomy, lymph node sampling, and possible removal of tubes and ovaries.
CPT code 58548 is a medical billing code used to describe a specific surgical procedure performed via laparoscopy. This procedure involves a radical hysterectomy, which is the removal of the uterus along with surrounding tissues, and is typically done to treat certain types of cancer. Additionally, the procedure includes a bilateral total pelvic lymphadenectomy, which is the removal of lymph nodes from both sides of the pelvic region, and para-aortic lymph node sampling or biopsy, which involves taking samples from lymph nodes near the aorta for further examination. If necessary, the procedure may also include the removal of one or both fallopian tubes and ovaries. This comprehensive surgical approach is aimed at thoroughly addressing malignancies within the pelvic region.
For CPT code 58548, 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 increased complexity or unusual patient anatomy.
2. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
3. Modifier 52 (Reduced Services): This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
4. Modifier 53 (Discontinued Procedure): Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. 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 prevent bundling of services that are typically considered part of a single procedure.
6. Modifier 62 (Two Surgeons): Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 (Surgical Team): Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
8. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier when a procedure is performed by the same physician during the postoperative period of another procedure, but the procedure is unrelated to the original.
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 policies, as requirements can vary.
The CPT code 58548 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service.
However, the actual reimbursement for CPT code 58548 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and set local coverage determinations, which can influence whether and how much a particular service is reimbursed.
Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 58548.
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