Women go through various uterine and reproductive diseases before and after menopause. One treatment method for these conditions is represented by the CPT code 58571. Specifically speaking, this code represents the removal of the uterus with ovaries and fallopian tubes.
The majority of gynecologists, however, are not aware of how to properly bill their services using this code. Therefore, we will learn the definition of CPT code 58571, its uses, and appropriate reimbursement rules in this article. Now, let’s begin.
CPT Code 58571 – Description
CPT code 58571 is maintained under the code range for ‘Laparoscopic/Hysteroscopic Procedures on the Corpus Uteri’.
The next question that arises is what happens during this procedure? It is a minimally invasive procedure, where the physician uses a laparoscope to perform a total hysterectomy for a uterus weighing 250 grams or less, and sometimes one or both fallopian tubes and/or ovaries may also be removed during this treatment.
This procedure is used to treat various conditions that are discussed in scenarios below.
Appropriate Use Cases for CPT Code 58571
Under this heading, we will discuss some real-life scenarios where the physicians may apply CPT code 58571 to bill their services.
Uterine Fibroids
Fibroids are uterine growths that can result in infertility, anemia, pelvic discomfort, and heavy bleeding. Approximately 1 in 4 women of reproductive age may develop uterine fibroids in the USA.
Let’s imagine a 38-year-old woman presents with pelvic pain and heavy menstrual flow that has persisted for a few months. She tells her gynecologist that she has been taking medicine for her ailment, but nothing has helped. She undergoes the necessary tests to check the size of the fibroids because the gynecologist suspects them. As a permanent solution, the gynecologist then performs a laparoscopic hysterectomy. It involves the surgical removal of the uterus, ovaries, and fallopian tubes. Because the procedure was performed on a uterus of normal weight (250 grams), the gynecologist applies CPT code 58571 to bill for these services.
Endometriosis
Another uterine problem called endometriosis occurs when tissue that resembles the lining of the uterus develops outside of it, leading to adhesions, infertility, or excruciating discomfort. Endometriosis usually affects 10% of women worldwide who are of reproductive age.
Let’s say that a 42-year-old woman goes to see her gynecologist. She has back discomfort and excruciating menstrual cramps both during and between periods. Additionally, she suffers from constipation and soreness while passing stool. The gynecologist ultimately opts for surgery after learning that the medical intervention she had earlier recommended didn’t work for the patient. A thorough laparoscopic hysterectomy removes the uterus and affected ovary, and fallopian tube. In this scenario, the physician can bill her surgical services with CPT code 58571.
Modifiers to Append with CPT Code 58571
Some modifiers that may be appended to CPT 58571 for coding specificity include:
Modifier 53
This refers to a discontinued procedure. If the service provider decides to discontinue the procedure after giving anesthesia due to severe health complications or excessive bleeding, he can report the discontinuation of services with modifier 53.
Modifier 80
You can append this modifier to CPT code 58571 to bill the services of an assistant surgeon involved in the procedure.
Modifier AS
Modifier AS must be used in place of modifier 80, only if the services of an assistant surgeon were rendered by a physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), or registered nurse first assistant (RNFA).
Reimbursement Guidelines for CPT Code 58571
You can refer to the following reimbursement guidelines for CPT code 58571 to avoid claim denials.
Ensure Correct Application of 58571
The most important fact to remember is that CPT code 58571 does not encompass open or vaginal hysterectomies. Rather, it denotes a complete laparoscopic hysterectomy. You can bill this code if the uterus (250 grams or less) is removed with either one or both of the ovaries or fallopian tubes. Any alternative method/ procedure may warrant a different CPT code.
Provide Detailed Documentation
You must demonstrate the medical necessity of your services so that the insurance payer will appropriately reimburse you. To demonstrate the need for the specified services, you must provide complete and accurate documentation. So, when using CPT code 58571, you must include the following details in your paperwork.
- Size of the uterus
- Type of procedure
- Mention if one or both fallopian tubes and/or ovaries were removed
- Time of surgery
- Type of anesthesia used
Be Mindful of the Global Period
The global period is usually set for a surgical procedure. Any services provided during the period cannot be billed separately. CPT code 58571 has a global period of 90 days. This indicates that the reimbursements for all required pre-, intra-, and post-operative services (for 90 days after the surgery) are bundled into a single payment.
Follow Payer-Specific Policies
Healthcare services are reimbursed by every payer according to their own guidelines. As a medical biller, it is crucial that you are aware of their evolving policies, payment schedules, and approved modifiers. However, some insurers also check to see if you obtained pre-authorization for the procedure. So, make sure you meet all the requirements set by the payer.
Final Thoughts on CPT Code 58571
To sum up, CPT code 58571 describes a complete laparoscopic hysterectomy in which the physician removes the uterus, ovaries, and fallopian tubes. This surgery is used to treat endometriosis, fibroids, and other uterine conditions. You can correctly file claims for this code by adding the appropriate modifiers and supporting documentation.
But despite following all of these recommendations, if you continue to receive denials for CPT code 58571, you can opt for OBGYN billing services provided by medical billing experts.
