CPT code 58552 is for a surgical procedure involving laparoscopy and vaginal hysterectomy, including the removal of tubes and/or ovaries.
CPT code 58552 is used to describe a surgical procedure that involves a laparoscopic-assisted vaginal hysterectomy for a uterus weighing 250 grams or less. This procedure also includes the removal of one or both fallopian tubes and/or ovaries. Laparoscopy is a minimally invasive surgical technique that uses small incisions and a camera to guide the surgery, while the vaginal hysterectomy involves removing the uterus through the vaginal canal. This code is specifically used for billing and documentation purposes to ensure accurate reimbursement for the healthcare provider performing this complex procedure.
For CPT code 58552, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to unusual complexity or difficulty.
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 52 (Reduced Services): Utilized when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 (Distinct Procedural Service): Used 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.
5. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Applied when a related procedure is performed during the postoperative period of the initial procedure.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a procedure is performed by the same physician during the postoperative period of another procedure, but is unrelated to the original procedure.
7. 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, if applicable.
8. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
9. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required for the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with current coding guidelines and payer-specific requirements, as these can vary.
The CPT code 58552 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 associated with CPT code 58552. The reimbursement amount can vary based on geographic location and other factors.
Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 58552. MACs are responsible for processing Medicare claims and ensuring that services meet the necessary coverage criteria. They may also have specific documentation requirements or prior authorization processes that healthcare providers must adhere to in order to receive reimbursement for this code.
Providers should consult the MPFS and their respective MAC's guidelines to ensure compliance and accurate billing for CPT code 58552.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 58552, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and safeguard your practice's financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
