Wednesday, October 26, 2016

CPT 59400, 58571, 58570, 58572, 58573 - Laparoscopy Hysterectomy surgical - full list

Total Laparoscopic Hysterectomy Procedure code

58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less $946

58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less, with removal of tube(s) and/or ovary(ies) $1,056

58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g 1,177

58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g, with removal of tube(s) and/or ovary(ies) 1,351

59400- Obstetrical care -  average fee payment - $2370 - $2380


Abdominal

58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)

58152 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz, Burch)

58180 Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)


Laparoscopic

58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less

58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g

58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less

58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g

58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)



Vaginal

58260 Vaginal hysterectomy, for uterus 250 g or less

58262 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)

58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele

58267 Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele

58275 Vaginal hysterectomy, with total or partial vaginectomy

58280 Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele

58290 Vaginal hysterectomy, for uterus greater than 250 g

58291 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58292 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele

58293 Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

58294 Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele


Laparoscopic-Assisted Vaginal

58550 Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 g or less

58552 Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g

58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)



Obstetrical Billing Guidelines

Services included in the Global OB CPT®’ Code 59400 (Vaginal delivery) or 59510 (Cesarean delivery) Note:

• The following information is applicable to Plans with maternity benefits.

• Maternity care is subject to a one-time office visit copayment. For BCBS plans with a copayment, this copayment should be
collected at the time of the initial OB office visit.

• Physicians will be reimbursed for the initial OB visit separately from the “global maternity care” and should submit a claim for this service at the time of the initial OB visit. Claims should include expected delivery date.

All subsequent office visits for maternity care and delivery are considered as part of the “global maternity care” reimbursement.

Submit claim upon delivery 


Amniocentesis Code amniocentesis separately from the global delivery code. Amniocentesis is not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarean delivery).

Ultrasounds Code ultrasounds separately from the global delivery code. Ultrasounds are not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarean delivery).

Where to Find More Information On Obstetrical Billing The answers to most obstetrical billing questions can be found in the “Physician’s Current Procedural Terminology (CPT)” manual. Maternity Care and Delivery is a subsection of the Surgery section. Surgical procedures are either package (global) services or starred procedures (non-global). An understanding of the global package services is needed to code Maternity Care and Delivery Services correctly. For additional resources on CPT coding, contact the American Medical Association (AMA) order desk at (800) 621-8335.


Global maternity care includes pregnancy-related antepartum care, admission to labor and delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum.

A global charge should be billed for maternity claims when all maternity-related services, as outlined in Blue Cross and Blue Shield of North Carolina’s (BCBSNC’s) corporate medical policy “Guidelines for Global Maternity Reimbursement,” are provided by the same physician or physicians practicing at the same location. The number of antepartum visits may vary from patient to patient; however, if global maternity care (more than three antepartum visits, delivery and postpartum care) is provided, all maternity-related visits should be billed under the global maternity code. Individual E&M codes should not be billed to report maternity-related E&M visits. Prenatal care is considered an integral part of the global reimbursement and will not be paid separately

The Current Procedural Terminology® (CPT) manual identifies the following CPT codes as global maternity services:
+ 59400 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

+ 59510 - Routine obstetric care including antepartum care, cesarean delivery and postpartum care

+ 59610 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after  previous cesarean delivery

+ 59618 - Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous  cesarean delivery

Billing tips:

+ An initial visit, confirming the pregnancy, is not a part of global maternity care services (verification of benefits will determine appropriate member liability).

+ A global charge should be billed when one or more physicians, practicing at the same location (filing under the same federal tax identification number), provide all components of the patient’s maternity care including; four or more antepartum visits, delivery and postpartum care. Note: Claims filed for partial maternity care with
E&M codes for one to three visits will deny when billed prior to the actual delivery, as all claims related to the maternity care must be received in order to account for the appropriate number of visits.

+ Antepartum services such as laboratory tests (excluding dipstick urinalysis), diagnostic ultrasound, amniocentesis,  ordocentesis, chorionic villus sampling, fetal stress test, and fetal non-stress test are not considered part of global  aternity services and should be billed separately.


Maternity billing codes

OB Global Billing:

59400 - Billed for vaginal delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22 or 52 modifier(s) appended.

59510 -Billed for c-section delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22, 52, AS, 80 modifier(s) appended.

59610 -Billed for VBAC delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22 or 52 modifier(s) appended.

59618 -Billed for c-section after attempted VBAC including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22, 52, AS,80 modifier(s) appended.


DESCRIPTION OF SERVICES

A hysterectomy is a surgical procedure to remove the uterus, and in some cases, the ovaries and fallopian tubes as well. In a total hysterectomy, the entire uterus, including the cervix, is removed. In a supracervical or partial hysterectomy, the upper part of the uterus is removed, but the cervix is left in place. Benign conditions that might be treated with a hysterectomy include uterine fibroids, endometriosis, pelvic organ prolapse and abnormal uterine bleeding.

Hysterectomies can be performed vaginally, abdominally or with laparoscopic or robotic assistance. In a vaginal hysterectomy, the uterus is removed through the vagina. In an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. A laparoscopic approach uses a laparoscope to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a small incision in or around the navel.

The scope has a small camera that projects images onto a monitor. Additional small incisions are made in the  abdomen for other surgical instruments used during the surgery. In a total laparoscopic hysterectomy, the uterus is removed in small pieces through the incisions or through the vagina. In a laparoscopic-assisted vaginal hysterectomy, the uterus is removed through the vagina, and the laparoscope is used to guide the surgery. In a robotic-assisted laparoscopic hysterectomy, the surgeon uses a robot attached to the instruments to assist in the surgery (ACOG, 2011).


Hysterectomies - Complications and Trauma 

CPT codes:

58150, 58152, 58180, 58200, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58541, 58542, 58543, 58544, 58545, 58546, 58550, 58552, 58553, 58554, 58570,  58571, 58572,58573,

Hysterectomy Services

Texas Medicaid reimburses hysterectomies when they are medically necessary. Texas Medicaid does not reimburse hysterectomies performed for the sole purpose of sterilization.

Providers can use any of the following procedure codes to submit claims for hysterectomy procedures:

Hysterectomy Acknowledgment

Hysterectomy services are considered for reimbursement when a signed Texas Medicaid - Title XIX Acknowledgment of Hysterectomy Information form is faxed to TMHP, the claim is filed with a signed Texas Medicaid - Title XIX Acknowledgment of Hysterectomy Information form, or documentation supporting that the Texas Medicaid - Title XIX Acknowledgment of Hysterectomy Information form could not be obtained or was not necessary.

All Texas Medicaid clients (including those in a STAR or STAR+PLUS Program health plan) receiving hysterectomy services must sign a Texas Medicaid - Title XIX Acknowledgment of Hysterectomy Information form. The acknowledgment must be submitted to TMHP with the claim or to the client’s health plan.

Procedure Codes

51925 58150 58152 58180 58200 58210 58240 58260 58262 58263 58267 58270 58275 58280 58285 58290 58291 58292 58293 58294 58541 58542 58543 58544 58548 58550 58552 58553 58554 58570 58571 58572 58573 59135 59525




CLINICAL EVIDENCE

Studies have shown that a vaginal approach to hysterectomy has fewer complications, requires a shorter hospital stay and is associated with better outcomes than a laparoscopic or abdominal approach.

A Cochrane review of 47 randomized controlled trials (n=5102) evaluating the abdominal, laparoscopic, and vaginal approach concluded that vaginal hysterectomy (VH) appears to be superior to laparoscopic and abdominal hysterectomy. VH is preferred to abdominal hysterectomy (AH) when possible, citing the advantages of a more rapid recovery and fewer postoperative complications of fever and/or infection. Where VH is not possible, a laparoscopic approach is preferred over AH with the same advantages as the vaginal approach, but requires a longer operating time and had more urinary tract injuries (Aarts et al., 2015).


A meta-analysis of five randomized studies comparing total laparoscopic hysterectomy (TLH) and VH for benign disease reported no differences in perioperative complications between the two procedures. TLH was associated with reduced postoperative pain scores and reduced hospital stay but took longer to perform. No differences in blood loss, rate of conversion to laparotomy or urinary tract injury were identified (Gendy et al., 2011).


Walsh et al. (2009) performed a meta-analysis of randomized controlled trials to compare outcomes in total abdominal hysterectomy (TAH) and TLH for benign disease in women who were not candidates for a vaginal approach. Results indicated that TLH is associated with reduced overall peri-operative complications and reduced estimated blood loss. Additionally, there are trends towards shorter hospital stay and postoperative hematoma formation compared to TAH. However, there were longer operating times in the TLH group. Although the rates of major complication were not statistically different, the authors note that this analysis is likely underpowered to detect many major complications. Larger studies are needed to assess the impact on major complications and long-term clinical outcomes.

Prophylactic Hysterectomy is a covered benefit when at least one of the following criteria is met:

1. Patients with known hereditary nonpolyposis colon cancer (HNPCC) who have completed childbearing.

2. Patients with an HNPCC associated mutation that have completed childbearing.

DESCRIPTION

Prophylactic Cancer Risk Reduction Surgery

Includes: Prophylactic Mastectomy

Prophylactic Oophorectomy

Prophylactic Total Gastrectomy

Prophylactic Hysterectomy

Prophylactic Thyroidectomy



Hysterectomy

ICD-10 Codes that apply:

Z15.04 Genetic susceptibility to malignant neoplasm of endometrium

Z15.09 Genetic susceptibility to other malignant neoplasm

Z40.09 Encounter for prophylactic removal of other organ

Z41.8 Encounter for other procedures for purposes other than remedying health state

Z80.0 Family history of malignant neoplasm of digestive organs

Z80.8 Family history of malignant neoplasm of other organs or systems

Z83.71 Family history of colonic polyps

Z86.010 Personal history of colonic polyps


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