CPT code 58570 is for a laparoscopic surgical procedure involving a total hysterectomy for a uterus weighing 250 grams or less.
CPT code 58570 is used to describe a surgical procedure known as a laparoscopic total hysterectomy for a uterus weighing 250 grams or less. This code is specifically assigned to a minimally invasive surgery where the uterus is removed through small incisions in the abdomen using a laparoscope, which is a thin, lighted tube that allows the surgeon to view the pelvic organs on a screen. The procedure is typically chosen for its benefits over traditional open surgery, such as reduced recovery time and less postoperative pain. This code is crucial for healthcare providers to accurately document and bill for the procedure, ensuring appropriate reimbursement from insurance companies.
For CPT code 58570, which involves a laparoscopic surgical procedure for a total hysterectomy for a uterus weighing 250 grams or less, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
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 indicates that more than one procedure was conducted.
3. Modifier 52 - Reduced Services: This is used when a service or procedure is partially reduced or eliminated at the discretion of the physician.
4. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier is applicable.
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: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
7. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is applicable.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This indicates that a procedure was repeated by a different provider.
10. 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 is used when a patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: This indicates that an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required on a limited basis.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is 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. It's important to use them appropriately to reflect the specifics of the surgical procedure accurately.
CPT code 58570 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this procedure is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
To ensure proper reimbursement, healthcare providers must submit claims that align with the guidelines set forth by their respective Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and providing guidance on coverage policies within their jurisdiction. It is crucial for providers to verify that the procedure is covered under the local coverage determinations (LCDs) or national coverage determinations (NCDs) applicable to their region.
Additionally, providers should ensure that all documentation and coding are accurate and complete to facilitate a smooth reimbursement process.
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 58570, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
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
