CPT code 58679 is used for procedures involving the oviduct or ovary that don't have a specific code, often for unique or uncommon surgeries.
CPT code 58679 is used to describe an unlisted laparoscopy procedure involving the oviduct or ovary. This code is typically utilized when a specific laparoscopic procedure performed on the oviduct or ovary does not have a designated CPT code. Because it is an "unlisted" code, healthcare providers must submit additional documentation to explain the nature of the procedure to ensure appropriate billing and reimbursement. This often involves detailing the procedure's complexity, duration, and any unique aspects that differentiate it from other listed procedures.
For CPT code 58679, which is an unlisted laparoscopy procedure for the oviduct or ovary, the use of modifiers can be essential to provide additional information about the procedure performed. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It 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. It indicates that the full service was not provided.
4. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: This is used when a team of surgeons is required to perform a complex procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by another physician or qualified healthcare professional.
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 modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required for the procedure.
14. 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.
15. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers provides specific information that can affect billing and reimbursement, and their use should be supported by appropriate documentation in the patient's medical record.
The CPT code 58679, which is categorized as an unlisted laparoscopy procedure for the oviduct or ovary, does not have a specific reimbursement rate listed in the Medicare Physician Fee Schedule (MPFS) because it is an unlisted procedure. Unlisted CPT codes like 58679 require additional documentation and justification for reimbursement consideration.
Medicare reimbursement for such codes is determined on a case-by-case basis by the Medicare Administrative Contractor (MAC) responsible for the provider's geographic region. The MAC will review the submitted documentation, which should include a detailed description of the procedure, the reason for its necessity, and any comparable procedures that have established reimbursement rates. Providers should ensure that they submit comprehensive documentation to facilitate the MAC's evaluation process for potential reimbursement.
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