CPT code 59618 is for routine obstetric care covering antepartum, cesarean delivery, and postpartum care after a prior cesarean attempt.
CPT code 59618 is used to describe the comprehensive package of routine obstetric care that includes antepartum care, the cesarean delivery itself, and postpartum care. This code is specifically applicable when there is an attempted vaginal delivery after a previous cesarean delivery, commonly referred to as a VBAC (Vaginal Birth After Cesarean). It encompasses the entire continuum of care provided to the patient, from the prenatal visits through the cesarean delivery and the postpartum follow-up, reflecting the additional complexities involved in managing such cases.
For CPT code 59618, the following modifiers may be applicable depending on the specific circumstances of the care provided:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. This could apply if there were significant complications or additional efforts during the cesarean delivery.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is used if the physician provides an evaluation and management service that is unrelated to the original procedure during the postpartum period.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.
4. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
5. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. 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.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: This modifier is used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier 90 - Reference (Outside) Laboratory: This modifier is used when laboratory procedures are performed by a party other than the treating or reporting physician.
15. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: This modifier is used if any part of the service was provided via telemedicine.
These modifiers should be used based on the specific circumstances surrounding the care provided and in accordance with payer policies and guidelines. Proper documentation is essential to support the use of any modifier.
The CPT code 59618 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 59618 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national policies and make coverage decisions that align with regional healthcare needs and practices. Therefore, healthcare providers should consult their local MAC for precise reimbursement details and any additional documentation requirements that may apply to CPT code 59618.
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