CPT code 58940 is for a surgical procedure involving the removal of one or both ovaries, either partially or completely.
CPT code 58940 is used to describe the surgical procedure of an oophorectomy, which involves the removal of one or both ovaries. This code can be applied whether the procedure is partial or total and whether it is performed on one side (unilateral) or both sides (bilateral) of the body. This code is crucial for healthcare providers to accurately document and bill for the surgical removal of ovarian tissue, ensuring proper reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 58940, which pertains to an oophorectomy, partial or total, 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 sides of the body. Although the code description includes bilateral, some payers may still require this modifier for billing purposes.
2. Modifier 51 - Multiple Procedures: If the oophorectomy 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 may be necessary if the oophorectomy is performed in a different session or site than other procedures.
4. Modifier LT - Left Side: This modifier specifies that the procedure was performed on the left ovary if the procedure is unilateral.
5. Modifier RT - Right Side: This modifier specifies that the procedure was performed on the right ovary if the procedure is unilateral.
6. 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.
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 primary and are working together as co-surgeons.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
Each modifier should be used in accordance with payer guidelines and specific clinical circumstances to ensure accurate billing and reimbursement.
The CPT code 58940 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare uses to reimburse healthcare providers for services rendered. However, the actual reimbursement for CPT code 58940 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 policies and establish local coverage determinations, which can influence whether and how much Medicare reimburses for this particular procedure. Therefore, healthcare providers should consult their respective MAC for precise reimbursement details and any additional documentation requirements.
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