CPT code 65755 is a medical billing code for a corneal transplant procedure.
CPT code 65755 is designated for a corneal transplant procedure, specifically referring to a penetrating keratoplasty. This involves the surgical replacement of a portion of the cornea with corneal tissue from a donor to restore vision impaired by corneal defects, diseases, or injuries.
For CPT code 65755, which is used for a corneal transplant, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of common modifiers that might be used with this code and the reasons for each:
1. -LT (Left side) and -RT (Right side): These modifiers are used to indicate which eye received the transplant. Since corneal transplants are specific to each eye, specifying the side is crucial for accurate medical records and billing.
2. -50 (Bilateral procedure): If corneal transplants are performed on both eyes during the same surgical session, this modifier would be used to indicate that the procedure was bilateral. However, bilateral corneal transplants are rare in a single session due to the complexity and risk involved.
3. -51 (Multiple procedures): This modifier is used when multiple procedures other than the corneal transplant are performed during the same surgical session. It helps in adjusting the reimbursement rates for the additional procedures.
4. -78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period): This modifier would be applicable if a return to surgery is required for a complication or related procedure shortly after the initial transplant.
5. -79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period): If another, unrelated procedure is performed during the postoperative period of the corneal transplant, this modifier would be used.
6. -22 (Increased procedural services): This modifier is used when the service(s) provided is greater than that usually required for the listed procedure. This could be due to extensive adhesions, severe scarring, or other complications that make the transplant more complex than usual.
7. -23 (Unusual anesthesia): Occasionally, if unusual anesthesia is required for the corneal transplant (beyond the typical local anesthesia), this modifier might be used.
8. -24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period): This modifier would be applicable if the patient requires an unrelated evaluation and management service during the postoperative period of the corneal transplant.
9. -53 (Discontinued procedure): If the corneal transplant is started but not completed due to unforeseen circumstances, this modifier would be used.
Each of these modifiers addresses specific scenarios that might arise during or after the procedure, impacting how the procedure is billed and reimbursed. It's important for coding and billing professionals in healthcare facilities to understand and correctly apply these modifiers to ensure accurate billing and optimal reimbursement for services rendered.
CPT code 65755, which pertains to a corneal transplant, is generally reimbursed by Medicare. The reimbursement for this procedure, however, can vary based on several factors including the geographic location of the service provider and the specific Medicare administrative contractor (MAC) policies in that region.
To determine the exact reimbursement amount, it is advisable to check the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or directly contact the local MAC. These resources will provide the most accurate and up-to-date information regarding the reimbursement rates for CPT code 65755 under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 65755 for corneal transplants, RevFind ensures that each claim with individual payers is thoroughly analyzed and appropriately compensated. Schedule a demo today to see how RevFind can streamline your billing process and safeguard your revenues.
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
