CPT code 58554 is for a surgical procedure involving laparoscopy with vaginal hysterectomy for a uterus over 250g, including tube or ovary removal.
CPT code 58554 is used to describe a surgical procedure involving a laparoscopy with a vaginal hysterectomy for a uterus that weighs more than 250 grams. This procedure also includes the removal of one or both fallopian tubes and/or ovaries. It is a minimally invasive technique that combines laparoscopic and vaginal surgical approaches to remove the uterus and possibly the tubes and ovaries, often used to treat conditions such as fibroids, endometriosis, or cancer. This code is essential for healthcare providers to accurately document and bill for the comprehensive nature of this surgical procedure.
For CPT code 58554, 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 complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the discretion of the physician.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient returns to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
7. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
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.
CPT code 58554 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 and the corresponding payment rates. However, it's important to note that reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether a particular service is reimbursed and at what rate. Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement of CPT code 58554.
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