CPT code 58262 is for a vaginal hysterectomy procedure involving the removal of a uterus weighing 250 g or less, along with tubes and/or ovaries.
CPT code 58262 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for a uterus that weighs 250 grams or less. This code also includes the removal of one or both fallopian tubes and/or ovaries during the same surgical session. This procedure is typically performed to treat various gynecological conditions such as uterine fibroids, endometriosis, or certain types of cancer. The use of this specific CPT code helps ensure accurate billing and documentation for healthcare providers, facilitating proper reimbursement from insurance companies.
For CPT code 58262, 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 additional time and effort needed during the 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 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Apply this modifier when a procedure or service was distinct or independent from other services performed on the same day.
5. 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.
6. 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.
7. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
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 58262 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 58262. The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. Each MAC may have slight variations in how they interpret and apply Medicare policies, which can affect the reimbursement process. Therefore, healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 58262.
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