CPT code 58900 is for a procedure involving the biopsy of one or both ovaries, performed as a distinct medical service.
CPT code 58900 is used to describe the procedure of performing a biopsy on the ovary, which can be done on one side (unilateral) or both sides (bilateral). This code is designated as a "separate procedure," meaning it is typically reported when the biopsy is performed independently and not as part of a more extensive procedure. In the context of healthcare billing and coding, this code helps ensure that the specific service of ovarian biopsy is accurately documented and reimbursed.
For CPT code 58900, which pertains to the biopsy of the ovary, unilateral or bilateral, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both ovaries. Although the code description includes "unilateral or bilateral," some payers may still require this modifier to indicate that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: If the biopsy is performed in conjunction with other procedures during the same surgical session, this modifier may be used to indicate that multiple procedures were performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the biopsy was a distinct procedural service from other services provided on the same day. It is particularly relevant if the biopsy is performed in a different anatomical site or through a separate incision.
4. Modifier 76 - Repeat Procedure by Same Physician: If the biopsy needs to be repeated by the same physician on the same day, this modifier is used to indicate the repeat nature of the procedure.
5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
6. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the biopsy is performed during the postoperative period of another procedure, and it is unrelated, this modifier is used.
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 58900 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the reimbursement for CPT code 58900 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and apply them to their specific region, which may affect the reimbursement process for this particular code. Therefore, healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for CPT code 58900.
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