CPT code 58573 is for a surgical laparoscopy involving a total hysterectomy for a uterus over 250g, including removal of tubes and/or ovaries.
CPT code 58573 is used to describe a laparoscopic surgical procedure that involves a total hysterectomy for a uterus weighing more than 250 grams. This procedure also includes the removal of one or both fallopian tubes and/or ovaries. This code is specific to cases where the surgery is performed using minimally invasive techniques, which typically result in shorter recovery times and less postoperative pain compared to traditional open surgery.
For CPT code 58573, 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 unusual pathology, anatomical variations, or other complexities.
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: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
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 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.
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 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but specifically used when a qualified resident surgeon is not available.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
These modifiers should be used based on the specific circumstances of the surgery and the documentation provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 58573 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for this procedure. The MPFS assigns a relative value unit (RVU) to CPT code 58573, which is then used to calculate the payment amount based on the geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and may have local coverage determinations (LCDs) that affect the reimbursement of CPT code 58573. These LCDs can include specific documentation requirements or medical necessity criteria that must be met for the procedure to be covered.
Healthcare providers should verify the specific reimbursement details for CPT code 58573 with their respective MAC to ensure compliance with any local policies and to understand the exact payment they can expect from Medicare.
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