CPT code 58575 is for a surgical laparoscopy involving total hysterectomy and tumor removal, including omentectomy and salpingo-oophorectomy.
CPT code 58575 is used to describe a surgical procedure performed via laparoscopy, which involves a total hysterectomy specifically for the resection of malignancy, often referred to as tumor debulking. This procedure includes the removal of the omentum (omentectomy) and may also involve the removal of one or both ovaries and fallopian tubes (salpingo-oophorectomy), if necessary. This code is typically utilized in cases where cancerous growths are present, and the surgery aims to remove as much of the tumor as possible to manage or treat the malignancy effectively.
For CPT code 58575, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 performed.
3. Modifier 52 - Reduced Services: This 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, each surgeon should report the procedure with this modifier.
7. Modifier 66 - Surgical Team: When a complex procedure requires a surgical team, this modifier is used to indicate that a team of surgeons worked together.
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 is used when a patient returns 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 a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required, this modifier is used to indicate their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required on a minimal basis.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier 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. Always verify with the latest coding guidelines and payer-specific policies, as requirements can vary.
The CPT code 58575 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, along with the associated reimbursement rates.
However, the actual reimbursement for CPT code 58575 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 and how much Medicare reimburses for this specific procedure.
Healthcare providers should consult their respective MAC for detailed information on coverage and reimbursement rates for CPT code 58575.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level. With RevFind, you can identify discrepancies for specific procedures, such as CPT code 58575, and ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see how RevFind can optimize your financial outcomes and streamline your billing processes.
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
