CPT code 58954 is for a complex surgical procedure involving the removal of ovaries, fallopian tubes, uterus, and lymph nodes to treat cancer.
CPT code 58954 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, combined with an omentectomy, which is the removal of the omentum, a layer of fatty tissue in the abdomen. Additionally, this code includes a total abdominal hysterectomy, the removal of the uterus through an incision in the abdomen, and a radical dissection aimed at debulking, which is the surgical reduction of tumor mass. The procedure also involves a pelvic lymphadenectomy, the removal of lymph nodes in the pelvic region, and a limited para-aortic lymphadenectomy, which targets lymph nodes near the aorta. This code is typically used in the context of treating certain gynecological cancers, where extensive surgical intervention is necessary to manage the disease.
For CPT code 58954, the following modifiers may be applicable:
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 unexpected findings during surgery.
2. Modifier 51 (Multiple Procedures): If multiple procedures are 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.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon performed a distinct part of the surgery.
5. Modifier 66 (Surgical Team): Use this modifier when a highly complex procedure requires the skills of several physicians, often of different specialties, working together as a team.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure needs to be repeated by the same physician, this modifier is used to indicate the repetition.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the 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 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 an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
11. Modifier 82 (Assistant Surgeon [when qualified resident surgeon not available]): This is used when an assistant surgeon is required, and a qualified resident is not available.
12. 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 of the procedure, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 58954 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 listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the actual reimbursement for CPT code 58954 can vary depending on the local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
These contractors are responsible for interpreting national policies and setting regional guidelines, which can influence whether a particular service is covered and at what rate it is reimbursed. Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC to confirm the reimbursement status and any specific requirements or documentation needed for CPT code 58954.
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