CPT code 58953 is for a surgical procedure involving the removal of ovaries, fallopian tubes, uterus, and surrounding tissues to reduce tumor size.
CPT code 58953 is used to describe a comprehensive surgical procedure that involves multiple components. Specifically, it refers to a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes. Additionally, it includes an omentectomy, which is the removal of the omentum, a layer of fatty tissue in the abdomen. The procedure also encompasses a total abdominal hysterectomy, meaning the complete removal of the uterus through an abdominal incision. Lastly, it involves a radical dissection for debulking, which is a surgical technique aimed at removing as much of a tumor as possible, often used in the treatment of ovarian cancer. This code is typically used in complex cases where extensive surgical intervention is necessary.
For the CPT code 58953, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. It may be applicable if the procedure was more complex or time-consuming than usual.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It may be relevant if additional procedures were performed alongside the primary procedure.
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 procedure was performed in a separate session or involved different sites.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. It may be applicable if the procedure required the expertise of two surgeons.
5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform a complex procedure. It may be relevant if the procedure involved multiple specialists working together.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: This modifier is used when a procedure or service is repeated by the same physician. It may be applicable if the procedure needed to be repeated for any reason.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by a different physician. It may be relevant if another physician needed to perform the procedure again.
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 when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 58953 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and healthcare providers for services rendered. However, the actual reimbursement for CPT code 58953 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
It is essential for healthcare providers to verify the specific guidelines and reimbursement rates with their regional MAC to ensure compliance and accurate billing.
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