CPT code 58952 is for the initial removal of ovarian, tubal, or peritoneal cancer, including extensive tissue removal for tumor reduction.
CPT code 58952 is used to describe a surgical procedure that involves the initial resection of ovarian, tubal, or primary peritoneal malignancy. 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 in the abdomen. Additionally, this code specifies that the surgery involves a radical dissection for debulking, meaning it includes the extensive removal or destruction of intra-abdominal or retroperitoneal tumors to reduce the tumor burden. This code is typically used in cases where a comprehensive surgical approach is necessary to manage and treat advanced gynecological cancers.
When billing for the CPT code 58952, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed bilaterally on both sides of the body.
2. Modifier 22 - Increased Procedural Services
Used when the procedure performed is significantly more complex or requires more time than typically required for the procedure.
3. Modifier 51 - Multiple Procedures
Used when multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Used when a subsequent procedure is planned or anticipated during the postoperative period of the initial procedure.
5. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
Used when the same procedure is repeated by a different physician on the same day.
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
Used when a patient returns to the operating room for a related procedure due to complications or other reasons.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Used when the same laboratory test is repeated on the same day to obtain subsequent results.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 58952 is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate and any applicable conditions. The MPFS provides a comprehensive list of services covered by Medicare, along with their respective payment rates, which are updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. They may have specific local coverage determinations (LCDs) that could affect the reimbursement of CPT code 58952. Therefore, healthcare providers should consult both the MPFS and their respective MAC for the most accurate and up-to-date information regarding the reimbursement of this particular code.
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