CPT code 58925 is used for the surgical removal of an ovarian cyst, whether it's on one or both ovaries.
CPT code 58925 is used to describe the surgical procedure known as an ovarian cystectomy, which involves the removal of a cyst from one or both ovaries. This code is applicable whether the procedure is performed on a single ovary (unilateral) or both ovaries (bilateral). Ovarian cystectomy is typically performed to remove cysts that may be causing pain, discomfort, or other health issues, and it can be part of a broader treatment plan for conditions affecting the ovaries. This code is essential for healthcare providers to accurately document and bill for the surgical services provided.
When billing for CPT code 58925, which pertains to an ovarian cystectomy, unilateral or bilateral, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the ovarian cystectomy is performed bilaterally. This indicates that the procedure was performed on both ovaries during the same surgical session.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the ovarian cystectomy was one of several procedures performed.
3. Modifier 59 - Distinct Procedural Service: Apply this modifier when the ovarian cystectomy is distinct or independent from other services performed on the same day. It is used to indicate that the procedure was not part of a more comprehensive service.
4. Modifier LT - Left Side: Use this modifier if the ovarian cystectomy is performed on the left ovary only. It specifies the side of the body where the procedure was performed.
5. Modifier RT - Right Side: Use this modifier if the ovarian cystectomy is performed on the right ovary only. It specifies the side of the body where the procedure was performed.
6. Modifier 22 - Increased Procedural Services: This modifier is applicable if the ovarian cystectomy required significantly more work than typically required. Documentation must support the increased complexity or time.
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: Use this modifier if the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
8. 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 of the initial surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the payer to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 58925 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 policies set by the Medicare Administrative Contractor (MAC) for the specific region.
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final determination of whether CPT code 58925 is reimbursed can vary based on local coverage determinations (LCDs) and other guidelines established by the MAC.
Therefore, healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement status and any specific requirements or limitations that may apply to CPT code 58925.
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