CPT code 58720 is for a surgical procedure involving the removal of one or both ovaries and fallopian tubes, either partially or completely.
CPT code 58720 is used to describe a surgical procedure known as a salpingo-oophorectomy. This procedure involves the removal of one or both of the fallopian tubes and ovaries. It can be performed as a complete or partial removal and can be done on one side (unilateral) or both sides (bilateral) of the body. The term "separate procedure" indicates that this code is used when the salpingo-oophorectomy is performed independently and not as part of another, more comprehensive surgical procedure. This code is crucial for healthcare providers to accurately document and bill for the surgical services provided, ensuring appropriate reimbursement and maintaining clear medical records.
For CPT code 58720, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both sides of the body. Since CPT code 58720 can be unilateral or bilateral, Modifier 50 would be appropriate if the procedure is performed bilaterally.
2. Modifier 51 - Multiple Procedures: If the salpingo-oophorectomy is performed in conjunction with other procedures during the same surgical session, Modifier 51 may be used to indicate multiple procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the salpingo-oophorectomy is performed in a separate anatomical site or through a separate incision.
4. Modifier LT - Left Side: If the procedure is performed only on the left side, Modifier LT should be used to specify the side of the body.
5. Modifier RT - Right Side: Similarly, if the procedure is performed only on the right side, Modifier RT should be used to indicate the side of the body.
6. Modifier 22 - Increased Procedural Services: If the procedure requires significantly more work than usual, Modifier 22 can be used to indicate increased procedural services.
7. 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 may be used if the patient returns to the operating room for a related procedure during the postoperative period.
Each modifier should be used in accordance with the specific details of the procedure and the payer's guidelines to ensure accurate billing and reimbursement.
The CPT code 58720 is reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, the specific reimbursement and coverage details can vary depending on the region, as they are influenced by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national policies and setting local coverage determinations, which can affect whether and how a particular service is reimbursed.
Therefore, healthcare providers should consult their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 58720.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 58720, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and safeguard your practice's financial health.
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
