Precision is the ultimate GPS to help you navigate the complexities of surgical billing, especially for minimally invasive procedures, like CPT code 58661.
Undoubtedly, this surgery significantly reduces the recovery time for patients. However, billing for this surgical laparoscopy procedure is not as simple as one might believe.
This ultimate guide breaks down everything you need to know about CPT 58661. From exploring real-world clinical scenarios to the appropriate application of modifiers, we will cover all to help you master it.
Thus, if you are an obstetrician and gynecologist (OBGYN) struggling with a higher denial rate and a strained revenue cycle, we recommend that you read this guide till the end.
CPT Code 58661 – Description
CPT code 58661 covers salpingo-oophorectomy using a laparoscope. It includes the removal of one or both fallopian tubes and one or both ovaries, or a combination of both.
Scenarios Where CPT Code 58661 is Applicable
Let’s understand the application of CPT 58661 with some real-world clinical scenarios:
Prophylactic Surgery for High Cancer Risk
Picture a 42-year-old female patient with a strong family history of ovarian cancer. She has tested positive for the BRCA1 gene mutation. Besides, she is post-menopausal and has completed childbearing.
Thus, the gynecologic oncologist performs a prophylactic bilateral salpingo-oophorectomy using a laparoscope. The aim is to reduce the patient’s lifetime risk of developing ovarian cancer. During the procedure, the healthcare provider removes both fallopian tubes and ovaries.
Here, CPT code 58661 applies.
Management of Ectopic Pregnancy
Consider a 32-year-old female patient who comes to the emergency room with acute abdominal pain. She required emergent surgical intervention after the rupture of an ectopic pregnancy confirmed in her left fallopian tube.
Thus, the gynecologist performs a laparoscopic left salpingectomy (removal of the fallopian tube). The provider also removed the adjacent left ovary since the rupture damaged it.
The gynecologist will report CPT code 58661 to bill for the service.
Treatment for Endometriosis and Ovarian Cyst
Imagine a 35-year-old female patient with severe, persistent pelvic pain. She has confirmed extensive Stage IV endometriosis and a large endometrioma (chocolate cyst) impacting the right ovary.
Thus, the gynecologist performs a laparoscopic right salpingo-oophorectomy to remove the diseased left ovary and fallopian tube. Here, CPT code 58661 applies.
Applicable Modifiers for CPT Code 58661
Here’s a list of all applicable modifiers related to the surgical laparoscopy procedure:
Modifier 50
What happens when you remove both ovaries and both fallopian tubes using a laparoscope? You append modifier 50 to CPT code 58661.
It indicates to the payer that the physician performed a bilateral procedure. It ensures you receive 150% of the standard fee schedule amount to justify the extra work done for the treatment of both sides.
Modifier 62
Append modifier 62 when two surgeons from different specialties, such as a gynecologic oncologist and a general surgeon, perform distinct and necessary parts of CPT code 58661.
Besides, you do not need to provide any additional documentation to prove the medical need for two surgeons (different specialties).
Modifiers 80, 81, 82, and AS
Did an assistant surgeon help the primary surgeon perform the service covered under CPT code 58661? If yes, the assistant surgeon must append one of the following relevant modifiers while billing for the service:
- 80 – A physician acted as the assistant to the primary surgeon.
- 81 – A physician provides minimal surgical assistance.
- 82 – A physician acted as an assistant in a teaching hospital where a qualified resident was unavailable.
- AS – A non-physician provider, such as a physician assistant (PA) or nurse practitioner (NP), helped perform the surgery.
Modifier LT
In case you performed the removal of the ovary, or fallopian tube, or both on the left side of the body via laparoscope, report modifier LT with CPT code 56881.
Modifier RT
What happens when you perform the surgical laparoscopy procedure on the right side of the body? You append modifier RT to CPT code 56881.
CPT Code 58661 – Billing & Reimbursement Guidelines
The following are the billing and reimbursement guidelines related to CPT 58661:
Fulfill Documentation Requirements
Detailed documentation is key to ensuring timely claim processing against CPT code 58661. It also helps demonstrate the medical necessity of the performed surgical laparoscopy procedure. Thus, ensure to include the following:
- Clearly state the pre-operative diagnosis that justifies the medical necessity of performing the surgery. These clinical indications include BRCA-positive, ovarian torsion, severe endometriosis, etc..
- Confirm the approach of removing the ovary and fallopian tube to be laparoscopic (minimally invasive).
- Specify which structures the physician removed, i.e., ovary, fallopian tube, or both.
- Mention the sides on which the physician performed the removal, i.e., left, right, or bilateral.
Use Appropriate Modifiers
Appropriate use of modifiers ensures coding specificity and accurate reimbursement. These also help prevent payment delays and claim denials. Some of the modifiers that apply to CPT 58661 are 50, 62, 80, 81, 82, AS, LT, and RT. You can find more details on their appropriate usage in the ‘Applicable Modifiers for CPT Code 58661’ section.
Understand Payer-Specific Policies
Payer policies significantly vary across federal programs (Medicare, Medicaid) and private payers. Therefore, always check with the relevant payer to understand specific requirements.
Below are a few variations for your reference:
- Some private payers require you to report modifiers LT and RT on two separate lines of your medical claim, instead of modifier 50.
- Verify if pre-authorization is needed for performing the surgical laparoscopy procedure covered under CPT code 58661. Several payers may not reimburse a preventive or elective laparoscopic salpingo-oophorectomy.
Summary
Phew! That’s what we call a comprehensive guide. It touched upon all aspects of accurately billing CPT code 58661. With that said, it is time to conclude it. However, before saying adieu, let’s quickly recap the key takeaways.
First, we explained the CPT 58661 descriptor. It covers salpingo-oophorectomy (removal of ovary, fallopian tube, or both) using a laparoscope.
Next, we shared a few real-world clinical scenarios. These include endometriosis and ovarian cyst treatment, prophylactic surgery for high cancer risk, and ectopic pregnancy management.
We also listed some of the applicable modifiers, including 50, 62, 80, 81, 82, AS, LT, and RT.
Finally, we discussed the billing and reimbursement guidelines.
Hopefully, these guidelines will help you get paid faster for your rendered surgical laparoscopy procedure. However, if you still struggle with denials and payment delays, feel free to outsource OBGYN billing services to MediBillMD.
