CPT code 65435 is for the procedure of curetting or treating the cornea.
CPT code 65435 is used to denote a medical procedure involving the curettage or treatment of the cornea. This typically involves the removal of damaged or diseased tissue from the cornea using a curette, a small, scoop-shaped surgical instrument. This procedure is often performed to treat various corneal conditions that may affect vision or eye health.
For CPT code 65435, which pertains to the curettage or treatment of the cornea, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is 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 was treated, as treatments may only be necessary on one side. This is crucial for accurate billing and medical records.
2. -50 (Bilateral procedure): If the procedure is performed on both eyes during the same operative session, this modifier should be used. It indicates that the service was bilateral, which can affect reimbursement.
3. -22 (Increased procedural services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the extra work and the reason for it.
4. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): This modifier is applicable if an evaluation and management service is performed during the postoperative period of the procedure that is not related to the original procedure.
5. -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure): Use this modifier if, on the day of the procedure, an additional evaluation and management service is needed that is significant and separately identifiable from the usual preoperative and postoperative care associated with the procedure.
6. -58 (Staged or related procedure or service by the same physician during the postoperative period): This modifier is used when a staged or related procedure is performed during the postoperative period of the initial procedure. It indicates that the subsequent procedure was planned at the time of the first procedure or is deemed necessary at the current stage of treatment.
7. -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 a complication from the initial procedure.
8. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a completely unrelated procedure is performed by the same physician during the postoperative period of the original procedure, this modifier should be used.
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 important for healthcare providers to use these modifiers correctly to avoid delays or denials in payment.
CPT code 65435, which pertains to the curettage treatment of the cornea, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on geographic location and the Medicare Administrative Contractor (MAC) responsible for that region. To determine the exact reimbursement rate, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or contact your local MAC. This will provide the most accurate and up-to-date information regarding the reimbursement for CPT code 65435.
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