CPT code 58950 is for the initial removal of ovarian, tubal, or peritoneal cancer, including both ovaries, fallopian tubes, and the omentum.
CPT code 58950 is used to describe a surgical procedure that involves the initial resection, or removal, of a malignant tumor located in the ovaries, fallopian tubes, or primary peritoneal area. This procedure includes a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes, as well as an omentectomy, which is the removal of the omentum, a layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen. This code is typically used by healthcare providers to document and bill for this comprehensive surgical intervention aimed at treating certain types of gynecological cancers.
For CPT code 58950, the following modifiers may be applicable depending on the specific circumstances of the procedure and the patient's condition:
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 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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon performs a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This is used when a team of surgeons is required to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different physician.
8. 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 related procedure is performed during the postoperative period of the initial surgery.
9. 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.
10. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required to help perform the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary, and a qualified resident is not available.
These modifiers should be applied based on the specific details of the surgical procedure and the circumstances under which it was performed. Proper documentation is essential to justify the use of any modifier.
The CPT code 58950 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 determine the reimbursement rates for various medical services, including surgical procedures.
To ensure accurate reimbursement, healthcare providers must also consider the policies of their respective Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and may have additional local coverage determinations or guidelines that affect the reimbursement of CPT code 58950. Therefore, it is crucial for providers to verify the specific requirements and documentation needed by their MAC to ensure proper billing and reimbursement for this procedure.
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