CPT code 58960 is for a surgical procedure to assess or reassess ovarian or related cancers, possibly involving tissue removal and lymph node examination.
CPT code 58960 is a medical billing code used to describe a surgical procedure known as a laparotomy, which is performed for the staging or restaging of ovarian, tubal, or primary peritoneal malignancy. This procedure, often referred to as a "second look," involves opening the abdominal cavity to assess the extent of cancer spread. It may include the removal of the omentum (omentectomy), washing of the peritoneal cavity to collect cells for examination (peritoneal washing), and taking biopsies of the abdominal and pelvic peritoneum. Additionally, the procedure includes an assessment of the diaphragm and may involve the removal of lymph nodes in the pelvic and limited para-aortic regions to check for cancer spread. This comprehensive approach helps in determining the stage of cancer and planning further treatment.
For CPT code 58960, 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 unusual pathology, extensive adhesions, or other complicating factors.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that the laparotomy was one of several procedures.
3. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the laparotomy was distinct or independent from other services performed on the same day. This is particularly relevant if other procedures were performed that are not typically bundled with the laparotomy.
4. Modifier 62 (Two Surgeons): If two surgeons were required to perform the procedure due to its complexity, this modifier should be used to indicate the collaborative effort.
5. Modifier 66 (Surgical Team): Apply this modifier if the procedure required a surgical team due to its complexity, indicating that multiple specialists were involved.
6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the procedure needed to be repeated by the same physician for any reason.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the procedure was 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): Use this if the patient needed to return to the operating room unexpectedly for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if the laparotomy was performed during the postoperative period of another procedure but is unrelated to the initial surgery.
These modifiers help provide additional context to the billing and coding process, ensuring accurate representation of the services provided. Always verify with the latest coding guidelines and payer-specific requirements.
The CPT code 58960 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). Whether this code is reimbursed by Medicare depends on several factors, including the specific coverage policies and guidelines set forth by the Medicare Administrative Contractor (MAC) that services the geographic region where the healthcare provider operates.
Each MAC has the authority to determine local coverage decisions, which can influence whether a particular CPT code, such as 58960, is reimbursed. Providers should consult the MPFS and their respective MAC's local coverage determinations to ascertain the reimbursement status of CPT code 58960.
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