CPT code 58956 is for a surgical procedure involving the removal of ovaries, fallopian tubes, omentum, and uterus due to cancer.
CPT code 58956 is used to describe a surgical procedure that involves the removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy), the removal of the omentum (total omentectomy), and the removal of the uterus through an abdominal incision (total abdominal hysterectomy). This procedure is typically performed to treat or manage malignancies, such as ovarian or uterine cancer. The comprehensive nature of this surgery aims to address the spread of cancer by removing affected and potentially affected tissues.
For CPT code 58956, 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 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: If the procedure needs to be repeated by the same provider, this modifier is used to indicate that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Similar to Modifier 76, but used when the repeat procedure is performed by a different provider.
6. 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.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
These modifiers help provide additional context and detail about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always ensure that the use of modifiers is supported by the medical documentation and aligns with payer policies.
The CPT code 58956 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the reimbursement rates for services provided to Medicare beneficiaries. The MPFS outlines the payment amounts for various CPT codes, including surgical procedures like 58956.
However, it's important to note that the reimbursement for CPT code 58956 can also be influenced by the specific policies of the Medicare Administrative Contractor (MAC) that services the geographic region where the healthcare provider operates. MACs are responsible for processing Medicare claims and have the authority to implement local coverage determinations (LCDs) that may affect the reimbursement of certain procedures.
Therefore, while CPT code 58956 is generally reimbursable under Medicare, healthcare providers should verify the specific reimbursement details with their respective MAC and consult the MPFS to ensure compliance with any regional or procedural nuances that may impact payment.
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