CPT code 58951 is for the initial removal of ovarian or related cancer, including hysterectomy and lymph node removal.
CPT code 58951 is used to describe a comprehensive surgical procedure for the treatment of certain types of cancer, specifically ovarian, tubal, or primary peritoneal malignancies. This code indicates that the surgery involves multiple components: the initial resection of the malignancy, a bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), an omentectomy (removal of the omentum, a layer of fatty tissue in the abdomen), a total abdominal hysterectomy (removal of the uterus through an abdominal incision), and a pelvic and limited para-aortic lymphadenectomy (removal of lymph nodes in the pelvic area and near the aorta). This extensive procedure is typically performed to manage and treat cancer that has spread or is at risk of spreading within the abdominal and pelvic regions.
For CPT code 58951, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
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 may be necessary if the procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure due to its complexity, this modifier indicates that both surgeons were necessary and actively involved.
5. Modifier 66 - Surgical Team: This modifier is applicable if the procedure required a surgical team due to its complexity or the patient's condition.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: If the procedure needed to be repeated by the same physician, this modifier would be used to indicate that the repeat was necessary.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure was repeated by a different physician, this modifier would be used to indicate the necessity of the repeat procedure.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon was required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify the necessity of each modifier with the specific payer's guidelines.
The CPT code 58951 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates, which are determined based on various factors including the complexity of the procedure and geographic location.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes like 58951. These LCDs can vary by region, so it is important for healthcare providers to verify the specific coverage policies and reimbursement rates applicable in their area.
To ensure accurate reimbursement, healthcare providers should consult the MPFS and communicate with their regional MAC to understand any specific documentation requirements or coverage limitations associated with CPT code 58951.
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 58951, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
