CPT code 58800 is for the drainage of ovarian cysts via a vaginal approach, applicable to one or both sides.
CPT code 58800 is used to describe the procedure of draining ovarian cysts through a vaginal approach. This code applies whether the cysts are located on one ovary (unilateral) or both ovaries (bilateral). The term "separate procedure" indicates that this code is typically reported when the drainage is performed independently and not as part of a more extensive surgical operation. This procedure is often necessary to relieve symptoms or prevent complications associated with ovarian cysts.
For CPT code 58800, which involves the drainage of ovarian cyst(s) via a vaginal approach, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their uses:
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 50 - Bilateral Procedure: Although the code description includes both unilateral and bilateral procedures, if the procedure is performed bilaterally and the payer requires it, this modifier may be used to indicate that the procedure was performed on both sides.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider.
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 modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. 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.
These modifiers should be applied based on the specific circumstances of the procedure and payer requirements. Proper documentation is essential to support the use of any modifier.
The CPT code 58800 is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate and any associated guidelines. The MPFS provides detailed information on the payment rates for services covered under Medicare Part B, including surgical procedures like the one associated with CPT code 58800.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining coverage specifics for services in their respective jurisdictions. Each MAC may have unique local coverage determinations (LCDs) that could affect the reimbursement of CPT code 58800. Therefore, healthcare providers should consult the relevant MAC for their region to ensure compliance with any local policies and to confirm the reimbursement status of this specific CPT code.
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