CPT CODES

CPT Code 58943

CPT code 58943 is for a surgical procedure involving the removal of one or both ovaries due to cancer, including lymph node and other assessments.

Table of Contents
What is CPT Code 58943
Does CPT 58943 Need a Modifier?
CPT Code 58943 Medicare Reimbursement
Are You Being Underpaid for 58943 CPT Code?
Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 58943

CPT code 58943 is used to describe a surgical procedure involving the removal of one or both ovaries (oophorectomy), which can be either partial or total. This procedure is specifically performed for cases involving ovarian, tubal, or primary peritoneal cancer. In addition to the oophorectomy, this code includes the biopsy of para-aortic and pelvic lymph nodes, peritoneal washings, peritoneal biopsies, and assessments of the diaphragm. The procedure may also involve the removal of one or both fallopian tubes (salpingectomy) and the removal of the omentum (omentumectomy), depending on the surgical requirements. This comprehensive approach is crucial for both the treatment and staging of malignancies in the pelvic and abdominal regions.

Does CPT 58943 Need a Modifier?

For CPT code 58943, the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. 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.

2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.

3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.

4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon must report the specific procedure code with this modifier.

5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform a complex procedure. Documentation should support the necessity of a team approach.

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 when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.

These modifiers should be applied based on the specific details and circumstances of the surgical procedure performed. Proper documentation is essential to support the use of any modifier.

CPT Code 58943 Medicare Reimbursement

CPT code 58943 is reimbursed by Medicare, subject to the guidelines and rates established in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 58943.

However, the reimbursement for this code can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting specific payment policies within their jurisdiction, which can influence the final reimbursement amount for CPT code 58943.

Healthcare providers should consult their respective MAC for detailed information on coverage and reimbursement specifics for this code.

Are You Being Underpaid for 58943 CPT Code?

Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 58943, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.

Get paid in full by bringing clarity to your revenue cycle

Get a Demo

Related CPT Codes

Full Page Background