CPT code 58660 is for a surgical laparoscopy procedure involving the removal of adhesions affecting the fallopian tubes or ovaries.
CPT code 58660 is used to describe a surgical procedure performed via laparoscopy that involves the lysis, or breaking down, of adhesions affecting the fallopian tubes (salpingolysis) or ovaries (ovariolysis). Adhesions are bands of scar tissue that can form after surgery or due to conditions like endometriosis, and they can cause pain or infertility by restricting the normal movement of the reproductive organs. This code is specifically for when the lysis of adhesions is performed as a separate procedure, meaning it is not bundled with other surgical interventions during the same operative session.
For CPT code 58660, 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 the complexity of the adhesions or other complicating factors.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that 58660 is one of several procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is particularly relevant if the lysis of adhesions is performed in a different anatomical site or through a separate incision.
4. 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 applicable if the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure is performed during the postoperative period of another surgery but is unrelated to the initial procedure.
6. Modifier LT - Left Side: If the procedure is performed on the left side of the body, this modifier specifies the laterality.
7. Modifier RT - Right Side: Similarly, if the procedure is performed on the right side, this modifier indicates the laterality.
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 requirements, as these can influence the use of modifiers.
The CPT code 58660 is reimbursed by Medicare, but its 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 outlines the payment amounts based on various factors, including the geographic location and the setting in which the service is provided.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of CPT code 58660. These LCDs can vary by region and may impose additional requirements or documentation to justify the medical necessity of the procedure.
Healthcare providers should consult the MPFS and their respective MAC's guidelines to ensure compliance with Medicare's reimbursement policies for CPT code 58660. This will help in understanding any specific criteria or documentation needed to secure reimbursement for this procedure.
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