The shortage of OBGYN staff and workload makes it more challenging for professionals to focus on billing and their services. We have decided to play our part while navigating these challenges. Claim denials usually occur due to negligence of minor details in claims. Therefore, this blog will explore all the details required for the billing of CPT code 58573.
You will learn about practical applications of the code, applicable modifiers, and thorough billing guidelines. This will help you secure timely payments and reduce the denial percentage on your claims. So let’s get started.
CPT Code 58573 – Description
CPT code 58573 is used to bill a procedure called “laparoscopic hysterectomy with surgical removal of the fallopian tubes and ovaries (salpingo-oophorectomy)”.
To elaborate on this description, it is a minimally invasive procedure during which the provider removes the uterus weighing more than 250 grams, cervix, and one or both fallopian tubes and/or ovaries.
This surgical procedure acts as a permanent treatment for several uterine conditions, some of which are discussed below.
Scenarios Where CPT Code 58573 is Applicable
You can refer to the following scenarios of CPT code 58573 to understand its practical applications.
Severe Endometriosis
A 45-year-old woman who had been receiving treatment for endometriosis returns to her gynecologist. She comes back with the same symptoms and reports that the medication has not been effective.
The gynecologist opts for a laparoscopic hysterectomy owing to the seriousness of her endometriosis. He makes a small incision in the abdomen to insert a thin, tube-like instrument to observe the inside of the patient’s body. Then he surgically removes the patient’s uterus, weighing more than 250 grams, cervix, and both of her fallopian tubes and ovaries. He carries out this whole procedure in one session. Therefore, he can charge for her surgical services using CPT code 58573.
Uterine Fibroids Affecting Ovaries
Let’s imagine another scenario where a 40-year-old woman visits her gynecologist complaining of constant pelvic pain and heavy menstrual bleeding that lasts for several months. The gynecologist initially takes her details and previous medical history. This process indicates that no other treatments had been effective on the patient.
So, the physician is left with only one option, which is to perform a laparoscopic hysterectomy. During the procedure, the surgeon finds that the fibroids are now impacting her ovaries. Therefore, she opts to remove the uterus, which weighs over 250 grams (due to fibroids), cervix, and the affected ovaries during the same surgical session. Hence, the gynecologist may use CPT code 58573 to bill for these services.
Applicable Modifiers for CPT Code 58573
You can apply the following modifier to CPT code 58573 depending on the situation.
Modifier 22
Modifier 22 refers to increased procedural services. You may only apply this modifier if the procedure was more complicated than normal and required more effort.
Modifier 80
Modifier 80 must be appended to CPT code 58573 if a professional provided complete surgical assistance during a laparoscopic total hysterectomy for a uterus over 250 grams.
Modifier 81
You may apply modifier 81 with CPT code 58573 if another qualified provider offered minimal surgical assistance for a brief duration due to an unforeseen, minor issue that occurred during the procedure. However, the procedure was originally intended to be conducted solely by the primary surgeon.
CPT Code 58573 – Billing & Reimbursement Guidelines
Finally, let’s understand some basic billing and reimbursement guidelines for CPT code 58573:
Pay Attention to the Details
You cannot forget the fact that every minor detail matters in medical billing. Let us point out one minor difference between CPT code 58573 and 58571. CPT code 58571 applies to a laparoscopic total hysterectomy for a uterus weighing “250 grams or less”. Whereas CPT code 58573 is designated for a laparoscopic total hysterectomy when the uterus weighs “more than 250 grams”.
Both codes represent a complete laparoscopic hysterectomy, indicating the removal of both the uterus and cervix, but only the weight of the uterus differentiates them from each other. Hence, you cannot afford to overlook such minor yet essential details in billing. These errors usually result in decreased payments or denials.
Take Account of Global Days
Another important fact is that whenever you bill for a surgical treatment, it is crucial to check its global period. This period is established by the Centers for Medicare and Medicaid Services (CMS) and indicates a single payment for the entire duration. This amount covers reimbursements for services rendered before the surgery (pre-op), during the surgery (intra-op), and after the surgery (post-op). Therefore, none of these services should be billed separately.
The global period for CPT code 58573 is 90 days. So, this includes a day of pre-operative care, the surgery day, and follow-up services for 90 days.
Maintain Proper Documentation
It is now a fact that your insurance payer requires appropriate documentation with complete information about the given services. You must present your paperwork with the relevant ICD-10 diagnosis codes. These codes demonstrate the medical necessity of the procedure. Additionally, your supporting documentation for CPT code 58573 claims must include these details:
- The accurate size of the removed uterus
- Mention if fallopian tubes or ovaries were removed
- Indicate the procedure type
- Time and day of the surgery
- Which type of anesthesia was used
- Presence of assistant surgeons (if applicable)
- The patients’ complete medical history
Final Word
To summarize, CPT code 58573 pertains to a complete laparoscopic hysterectomy where the physician removes the uterus, which weighs over 250 grams, cervix, ovaries, and fallopian tubes. You may apply this code in cases like serious endometriosis, uterine fibroids, and other uterine problems.
However, if the surgery was performed with the help of another professional, you must denote this with modifier -80 or -81. While finalizing your documents, you must pay special attention to aspects like understanding global surgery days and ensuring proper documentation.
If you are still experiencing challenges or claim denials, take action by contacting an OBGYN billing services provider. Such professional billing companies can address ongoing coding issues and ensure you remain compliant with the latest rules. As a result, you reduce the risk of future claim denials.
