CPT code 58553 is for a surgical procedure involving laparoscopy with vaginal hysterectomy for a uterus weighing over 250 grams.
CPT code 58553 is used to describe a surgical procedure that involves a laparoscopy-assisted vaginal hysterectomy for a uterus that weighs more than 250 grams. This code is specific to a minimally invasive technique where the surgeon uses a laparoscope, a small camera inserted through a small incision in the abdomen, to assist in the removal of the uterus through the vaginal canal. This procedure is typically chosen for its benefits of reduced recovery time and minimized scarring compared to traditional open surgery.
For CPT code 58553, which involves a laparoscopy with vaginal hysterectomy for a uterus greater than 250 grams, 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. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.
3. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is 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.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the distinct parts of the procedure, this modifier is used to indicate the collaborative effort.
7. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is necessary 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: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 58553 is reimbursed by Medicare, but the reimbursement is subject to several factors. 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 58553. The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. Each MAC may have slightly different policies and guidelines, so it's important for healthcare providers to verify the specific reimbursement details with their local MAC to ensure accurate billing and optimal reimbursement for services rendered.
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