CPT code 58572 is for a surgical laparoscopy procedure involving a total hysterectomy for a uterus weighing over 250 grams.
CPT code 58572 is used to describe a laparoscopic surgical procedure involving a total hysterectomy for a uterus that weighs more than 250 grams. This code is specifically utilized when the surgery is performed using minimally invasive techniques, where small incisions and a camera are used to remove the uterus. 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 healthcare providers to accurately document and bill for the specific surgical services provided during the hysterectomy.
For CPT code 58572, which involves a laparoscopic surgical procedure for a total hysterectomy for a uterus greater than 250 grams, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
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 factors such as unusual anatomy or extensive adhesions.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are primary surgeons.
7. Modifier 66 - Surgical Team: When a team of surgeons is required to perform the procedure, this modifier indicates the involvement of a surgical team.
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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required 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 is important to review the specific payer guidelines and documentation requirements when applying these modifiers.
The CPT code 58572 is reimbursed by Medicare, provided that the procedure meets the necessary medical necessity criteria and documentation requirements.
Reimbursement rates for this code can be found in the Medicare Physician Fee Schedule (MPFS), which outlines the payment amounts for services covered under Medicare Part B.
It's important to note that the reimbursement may vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC).
The MAC is responsible for processing claims and ensuring compliance with Medicare policies in their respective jurisdictions.
Healthcare providers should verify the specific reimbursement details and any additional requirements with their local MAC to ensure proper billing and payment for CPT code 58572.
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