CPT code 65850 is a medical code for the surgical procedure involving an incision of the eye.
CPT code 65850 is designated for procedures involving the incision of the trabecular meshwork of the eye, typically performed to treat glaucoma by enhancing aqueous fluid outflow to lower intraocular pressure. This code is used specifically for the surgical procedure known as trabeculotomy.
For the CPT code 65850, which pertains to the incision of the eye, 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) - Used to specify that the procedure was performed on the left eye.
2. -RT (Right side) - Used to specify that the procedure was performed on the right eye.
3. -50 (Bilateral procedure) - Applied when the procedure is performed on both eyes during the same operative session.
4. -51 (Multiple procedures) - Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement for the additional procedures.
5. -59 (Distinct procedural service) - Indicates that the procedure was distinct or independent from other services performed on the same day.
6. -76 (Repeat procedure by same physician) - Used if the procedure is repeated by the same physician on the same day.
7. -77 (Repeat procedure by another physician) - Used if the procedure is repeated by a different physician on the same day.
8. -78 (Unplanned return to the operating/procedure room) - Applied when a patient returns to the operating or procedure room for a related procedure during the postoperative period.
9. -79 (Unrelated procedure or service by the same physician during the postoperative period) - Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. -XE (Separate encounter) - A service that is distinct because it occurred during a separate encounter.
11. -XS (Separate structure) - A service that is distinct because it was performed on a separate organ/structure.
12. -XP (Separate practitioner) - A service that is distinct because it was performed by a different practitioner.
13. -XU (Unusual non-overlapping service) - The use of a service that is distinct because it does not overlap usual components of the main service.
Each modifier provides specific information that affects how billing and reimbursement are handled, ensuring accurate representation of the services provided. It's crucial for healthcare providers to use the appropriate modifiers to avoid payment delays and denials.
CPT code 65850, which pertains to the incision of the eye, specifically trabeculotomy ab externo, is generally reimbursed by Medicare. However, the actual reimbursement amount for this procedure can vary based on several factors including the geographic location of the service, the setting in which the procedure is performed (hospital outpatient department vs. ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for the specific region.
To determine the exact reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on the reimbursement rates for specific CPT codes based on the locality. Additionally, checking with the local MAC can provide insights into any specific documentation requirements or coverage limitations related to this procedure.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 65850 for incision of the eye, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring accurate payments for every procedure code, including individual payer details.
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