CPT code 65272 is a medical billing code for the surgical repair of an eye wound.
CPT code 65272 is designated for the surgical repair of an eye wound. This procedure involves the closure and treatment of a laceration or injury to the eye, typically requiring precise and specialized surgical intervention to restore function and prevent further damage to ocular structures.
For the CPT code 65272, which pertains to the repair of an eye wound, several modifiers may be applicable depending on the specific circumstances of the procedure. Here’s an ordered list of potential modifiers and the reasons for their use:
1. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye underwent the procedure, essential for clarity in billing and medical records.
2. -50 (Bilateral procedure): If the procedure was performed on both eyes during the same operative session, this modifier should be used to indicate a bilateral service.
3. -51 (Multiple procedures): This modifier is used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.
4. -52 (Reduced services): Indicates that the service provided was less than usually required. This could be applicable if only a part of the typical repair procedure was necessary.
5. -53 (Discontinued procedure): Used if the surgery is terminated after the patient is prepared but before the procedure is completed due to extenuating circumstances or those that threaten the well-being of the patient.
6. -54 (Surgical care only): When one physician performs the surgery and another provides preoperative and/or postoperative management.
7. -55 (Postoperative management only): Used by a physician who provides postoperative management but did not perform the surgery.
8. -56 (Preoperative management only): Indicates that a physician provided only the preoperative care and did not perform the surgery.
9. -58 (Staged or related procedure or service by the same physician during the postoperative period): This can be used if a subsequent procedure is planned at the time of the first procedure or is more extensive than the original.
10. -59 (Distinct procedural service): Indicates that procedures that are normally bundled into one payment were performed in separate sessions or patient encounters, which may be necessary if different aspects of the eye wound require separate attention.
11. -78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period): This modifier is used when a return to the operating room is required to address complications or related issues from the initial procedure.
12. -79 (Unrelated procedure or service by the same physician during the postoperative period): If another procedure, unrelated to the eye wound repair, is performed during the postoperative period.
13. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): For E/M services during a postoperative period that are not related to the original procedure.
Each of these modifiers provides specific information that helps in the accurate processing of claims and ensures appropriate reimbursement for the services rendered. It’s crucial for healthcare providers to use these modifiers correctly to avoid denials and to facilitate efficient revenue cycle management.
CPT code 65272, which pertains to the repair of an eye wound, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service, the setting in which the procedure is performed (such as inpatient or outpatient), and the Medicare Administrative Contractor (MAC) policies for that region.
To determine the exact reimbursement amount for CPT code 65272, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. Additionally, it's important to ensure that all documentation and coding are accurately completed to meet Medicare's requirements for medical necessity and compliance to avoid denials or audits.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 65272 for repair of eye wound, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure code, including individual payer details. Take the first step towards optimizing your reimbursements with MD Clarity.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
