CPT code 58550 is for a surgical laparoscopy with vaginal hysterectomy for a uterus weighing 250 grams or less.
CPT code 58550 is used to describe a surgical procedure that involves a laparoscopy-assisted vaginal hysterectomy for a uterus weighing 250 grams or less. This code is specifically utilized when a surgeon performs a minimally invasive laparoscopic approach to assist in the removal of the uterus through the vaginal canal. The procedure is typically chosen for its benefits of reduced recovery time and less postoperative pain compared to traditional open surgery. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that healthcare providers are reimbursed appropriately for the services rendered.
For CPT code 58550, which involves a laparoscopy with vaginal hysterectomy for a uterus weighing 250 grams or less, the following modifiers may be applicable:
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: If multiple procedures are performed during the same surgical session, this modifier indicates that multiple procedures were performed. It helps in the correct billing and reimbursement process.
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 53 - Discontinued Procedure: This modifier is applicable 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are primary surgeons.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires a surgical team. It indicates that multiple professionals were involved in the surgery.
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 when a patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
These modifiers help in accurately describing the circumstances under which the procedure was performed, ensuring proper billing and reimbursement. Always ensure that documentation supports the use of any modifier applied.
The CPT code 58550 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 58550. However, the actual reimbursement can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have its own local coverage determinations (LCDs) that can affect whether and how a particular service is reimbursed. Therefore, it is crucial for healthcare providers to verify the coverage and reimbursement details with their respective MAC to ensure compliance and proper billing practices.
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