CPT code 58920 is for a surgical procedure involving the removal of part of one or both ovaries, known as a wedge resection or bisection.
CPT code 58920 is used to describe a surgical procedure known as a wedge resection or bisection of the ovary, which can be performed on one ovary (unilateral) or both ovaries (bilateral). This procedure involves the removal of a wedge-shaped portion of ovarian tissue, often to treat conditions such as ovarian cysts or tumors, or to improve fertility in certain cases. The code is utilized by healthcare providers to accurately document and bill for this specific surgical intervention within the medical billing and coding system.
For CPT code 58920, which involves a wedge resection or bisection of the ovary, unilateral or bilateral, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if 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 wedge resection or bisection of the ovary is performed in conjunction with other procedures during the same surgical session, this modifier may be used to indicate multiple procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used when the procedure is distinct or independent from other services performed on the same day. It may be necessary if the procedure is performed in a different anatomical site or for a different reason than other procedures.
4. Modifier LT - Left Side: If the procedure is performed only on the left ovary, this modifier specifies the side of the body.
5. Modifier RT - Right Side: If the procedure is performed only on the right ovary, this modifier specifies the side of the body.
6. Modifier 22 - Increased Procedural Services: This modifier is used if the procedure required significantly more work than typically required, due to complications or other factors.
7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are equally responsible for the procedure.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates the involvement of an assistant.
These modifiers help provide additional information to payers about the specifics of the procedure performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as requirements for modifiers can vary.
The CPT code 58920, which involves a surgical procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 58920 is reimbursed, healthcare providers should consult the MPFS to verify if the procedure is listed and to understand the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage determinations within their jurisdictions. Therefore, it is essential for healthcare providers to check with their specific MAC to confirm if CPT code 58920 is covered and to understand any local coverage determinations (LCDs) that might affect reimbursement.
In summary, while CPT code 58920 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any specific coverage guidelines or requirements.
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