Did you know that around 600,000 hysterectomy procedures are performed in the USA each year? In fact, it is the most common non-obstetric surgical procedure among American women.
Despite its high prevalence, many gynecological practices struggle to report this procedure for rightful reimbursement collection from medical insurance payers.
In today’s ultimate guide, we will uncover the nuances of billing CPT code 58570, including its applicable modifiers and documentation requirements, to ensure you receive fair compensation for the performed hysterectomies using laparoscopy.
CPT Code 58570 – Description
The Current Procedural Terminology (CPT) code 58570 reports a minimally invasive surgical laparoscopy with a total hysterectomy. The gynecologist removes the uterus, weighing 250 grams or less, and the cervix by making a small incision in the lower abdomen. She inserts the laparoscope (a thin tube with a camera and light on the other end) through the incision to perform the camera-guided surgery or total hysterectomy.
CPT code 58570 falls under the code range ‘Laparoscopic/Hysteroscopic Procedures on the Corpus Uteri’ as maintained by the American Medical Association (AMA). The surgery is performed under general anesthesia and typically lasts between 2-3 hours.
Medicare Part B covers surgical laparoscopy with total hysterectomy, given that the procedure was medically necessary. The surgery can be performed at ambulatory surgical centers (ASC) or hospital outpatient departments. The current Medicare reimbursement rate for CPT code 58570 is between $713.76 and $997.93, depending on the MAC facility and locality.
Scenarios Where CPT Code 58570 is Applicable
A hysterectomy, where the gynecologist removes a normal uterus (weighing 250 grams or less) and the cervix, may be required to treat a range of gynecological conditions such as heavy bleeding during menstruation, fibroids, endometriosis, uterine prolapse, and cervical or uterine cancer.
Let’s look at a few real-world examples where CPT code 58570 can be accurately applied for reimbursement collection.
Laparoscopic Hysterectomy to Treat Uterine Fibroids
Uterine fibroids are one of the most common conditions among women between the ages of 30 and 50. Up to 70% of women develop fibroids during their reproductive years. These non-cancerous growths develop in and on the uterus and are made of the same tissues and muscles as the uterus wall. While small fibroids are generally left untreated, larger fibroids trigger uncomfortable symptoms like heavy bleeding during menstruation, abdominal pain or bloating, frequent urination, and vaginal discharge.
Now, imagine that a 48-year-old woman visits her gynecologist complaining of all the symptoms we have mentioned above. Her gyne orders an ultrasound, and the test results confirm the presence of large and numerous fibroids inside the uterus. The gyne asks the woman if she is planning more pregnancies in the future. The woman says she already has 3 children and does not want to carry anymore. They mutually agree to remove the uterus and cervix as a permanent treatment for uterine fibroids.
The surgical laparoscopy with a total hysterectomy is planned and performed. After stitching up the incision, the patient is kept under observation for a few hours to rule out postoperative complications. Upon signs of a healthy recovery, she is discharged from the hospital the same day, and CPT code 58570 is reported for billing purposes.
Total Hysterectomy with Laparoscopy for Severe Endometriosis
According to the Office on Women’s Health, around 11% of women in the USA between the ages of 15 and 44 are affected by endometriosis. It is a condition where the tissue of the uterine lining starts to grow outside the uterus. Common symptoms of endometriosis include pelvic pain or menstrual cramps, heavy bleeding during periods, spotting between two periods, pain during sex, and infertility.
Consider that a woman in her mid-30s and with a family history of endometriosis visits her gynecologist and complains of the symptoms we have mentioned above. She is recommended an ultrasound. The images reveal abnormal tissue growth behind the uterus and on the cervix. First, her gyne prescribes hormonal birth control pills to relieve the discomfort and pain during periods. However, after learning that the patient intends to live a child-free life, the gyne recommends uterus and cervix removal to treat endometriosis permanently.
A date is set for the surgery, and the gyne performs a total hysterectomy using laparoscopy under general anesthesia. The patient’s insurance payer is billed for the procedure using CPT code 58570.
Uterus and Cervix Removal to Treat Uterine Cancer
Uterine cancer is of 2 types – endometrial cancer, which is more common, and uterine sarcoma, which is rare. According to the American Cancer Society, “Endometrial cancer is the fourth most common cancer for women in the United States”. They further state that 69,120 new cases of uterine cancer are diagnosed annually. Common symptoms of uterine cancer include bleeding between two periods or after menopause.
Consider that a 62-year-old menopausal woman visits her gynecologist complaining of spotting. The gyne recommends a transvaginal ultrasound to get images of the uterus. The results indicate endometrial cancer in the inner lining of the uterus. Since the patient is past her child-bearing age, the gyne recommends a total hysterectomy using laparoscopy to remove the uterus and cervix.
The laparoscopic surgery is performed under general anesthesia, and after keeping the patient under observation for possible postoperative complications for a night, the patient is sent home. The gyne reports CPT code 58570 on the insurance claim form for appropriate reimbursement for the surgery.
Applicable Modifiers for CPT Code 58570
Let’s discuss some of the modifiers that you can append with CPT code 58570 for improved coding specificity.
Modifier 22
You must append modifier 22 to CPT code 58570 if more work was required during the procedure than is typically necessary. This means that if, due to technical difficulties or the patient’s worsening health condition, you had to spend more time and effort to perform the procedure successfully, then modifier 22 can be appended to indicate increased procedural services. You can collect up to 25% more of the allowed amount by appending modifier 22.
Modifier 51
If the situation made it necessary to perform two or more procedures during the same surgical session, then modifier 51 must be appended to explain this.
For example, if you were initially performing a laparoscopic biopsy and, upon discovering large fibroids in a woman past her child-bearing age, decided to proceed with a total hysterectomy, then modifier 51 must be appended to the subsequent procedural code (CPT code 58570 in this case).
Modifier 53
Appending modifier 53 to CPT code 58570 would indicate that you administered the general anesthesia and started the surgical procedure but had to terminate it midway due to extenuating circumstances that threatened the patient’s well-being.
Modifier 59
If you performed other services or procedures prior to laparoscopy with total hysterectomy, you must append modifier 59 with code 58570 to indicate that the surgery is distinct and separately billable.
However, modifier 59 should only be used if modifiers X{EPSU} do not specifically describe how the service was distinct from another one performed on the same day.
Modifier 78
The global surgery period for CPT code 58570 is 90 days. Therefore, the patient can receive care for postoperative complications for 90 days from the date of surgery.
If complications arise and the patient’s return to the operating room is unplanned, the gynecologist and her billing team can append modifier 78 to the surgical code to explain this. It indicates that the patient’s return to the operating room was unplanned but related to the surgery and occurred within its postoperative period.
Modifier 79
Contrarily, if the patient returned to the operating room but for an unrelated procedure within the postoperative period of a total hysterectomy using laparoscopy, modifier 79 will be appended to indicate this.
Modifier 81
Modifier 81 indicates that an assistant surgeon offered minimal support during the laparoscopy. For example, the assistant surgeon was present during the uterus and cervix removal to help maintain homeostasis.
CPT Code 58570 – Billing & Reimbursement Guidelines
Whether or not you receive the reimbursement, its final amount, and the time it takes to process your claim will depend on how efficient is your billing workflow. Errors during the billing process, like coding inaccuracy, will trigger a claim denial and impede revenue collection.
Therefore, you must follow the billing guidelines we have specified for CPT code 58570 if you want to maintain the financial stability of your gynecological practice.
Review Each Payer’s Coverage Policies
Every Medicare Administrative Contractor (MAC) has its own local coverage determinations (LCDs) or national coverage determinations (NCDs) that specify coverage policies based on its jurisdiction. You must thoroughly review these documents to check if the surgical procedure is covered, its limitations (if any), and how to bill it to ensure a clean first-pass claim submission.
Ensure Comprehensive Documentation
You must make sure that your documentation is accurate and complete and supports the medical necessity of a total hysterectomy using laparoscopy. You should attach lab test reports, clinical notes, surgical notes, referral letters, patient consent forms, and all the relevant documents with the medical claim form as supporting evidence.
Append Modifiers when Needed
Modifiers provide supplemental information to the insurance payers, helping them understand the exact circumstances under which the procedure was performed. Failing to use the appropriate modifier when needed can adversely affect your final reimbursement rate. Hence, use the modifiers when necessary to ensure coding specificity.
Pair with the Accurate Diagnostic Code
You can only prove the medical necessity of a surgical laparoscopy with total hysterectomy (CPT code 58570) when it accurately matches the ICD-10 diagnostic code. For example:
- D25.9 for leiomyoma of the uterus, unspecified,
- N80.0 for endometriosis of the uterus,
- C54.1 for malignant neoplasm of the endometrium,
These are some of the applicable diagnostic pair codes for CPT 58570.
File the Claim On Time
Timely claim filing is essential if you want your claims to get processed and paid. Ensure that your billing team is aware of the filing deadlines set by each insurance payer and submits error-free claims before the due date.
A good practice is to let third-party medical billers handle claim creation and submission. Their OBGYN medical billing services include accurate coding, compliance checks, and streamlined communication to expedite insurance claim submissions.
Takeaway
Let’s quickly summarize what we learned in this comprehensive guide on CPT code 58570. The code reports a minimally invasive, camera-guided surgery to remove the uterus and cervix. The patient’s uterus must weigh 250 grams or less for the code to be applicable. Conditions that necessitate a total hysterectomy using laparoscopy include large uterine fibroids, uterine cancer, and severe endometriosis.
Next, we discussed the modifiers that can be appended to CPT code 58570 for coding specificity. These include modifiers 22, 51, 53, 59, 78, 79, and 81. Besides, billing practices, like ensuring documentation accuracy and completeness, reporting correct diagnostic codes, reviewing payer-specific guidelines, and submitting claims on time, can help you avoid claim denials.
