CPT code 58805 is for the drainage of ovarian cysts via an abdominal approach, applicable to one or both sides as a separate procedure.
CPT code 58805 is used to describe the surgical procedure for draining ovarian cysts, whether they are on one side (unilateral) or both sides (bilateral) of the ovaries. This procedure is performed through an abdominal approach, meaning the surgeon accesses the cysts by making an incision in the abdominal area. It is categorized as a "separate procedure," indicating that it is typically performed independently and not as part of a more extensive surgical operation. This code is essential for healthcare providers to accurately document and bill for the specific service rendered during the treatment of ovarian cysts.
For CPT code 58805, which involves the drainage of ovarian cyst(s) via an abdominal approach, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both ovaries during the same operative session. Although the code description mentions unilateral or bilateral, some payers may still require this modifier for billing purposes.
2. Modifier 51 - Multiple Procedures: If the drainage of ovarian cysts is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
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 is particularly useful if the procedure is performed in a different anatomical site or through a separate incision.
4. Modifier 22 - Increased Procedural Services: If the procedure required significantly more work than typically required, this modifier can be used to indicate the increased complexity or time involved.
5. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left ovary when the procedure is unilateral.
6. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right ovary when the procedure is unilateral.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the procedure is performed as an unplanned return to the operating room during the postoperative period of another surgery, this modifier is applicable.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the procedure is performed during the postoperative period of another surgery but is unrelated to the initial procedure.
These modifiers help provide additional information to payers about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as requirements for modifiers can vary.
The CPT code 58805 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. Each MAC, which is responsible for processing Medicare claims, may have specific local coverage determinations (LCDs) that influence whether a particular service, such as the one represented by CPT code 58805, is reimbursed.
It is crucial for healthcare providers to verify the reimbursement status of CPT code 58805 with their respective MAC to ensure compliance with local policies and to understand any documentation requirements that may affect reimbursement.
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, including CPT code 58805. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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