CPT code 66155 is a medical billing code for a specific type of glaucoma surgery.
CPT code 66155 is designated for a surgical procedure specifically targeting the treatment of glaucoma. This code is used to describe a trabeculotomy ab externo, a procedure where an incision is made into the eye's trabecular meshwork to improve fluid drainage from the eye, thereby helping to reduce intraocular pressure associated with glaucoma. This procedure is crucial for patients experiencing certain types of glaucoma, where other medical treatments or less invasive surgeries have not been effective.
For CPT code 66155, which pertains to glaucoma surgery, several modifiers may be applicable depending on the specific circumstances of the surgery and billing requirements. 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 indicate which eye underwent the procedure, as glaucoma surgery is typically performed on one eye at a time.
2. -50 (Bilateral Procedure): If the glaucoma surgery is performed on both eyes during the same operative session, this modifier should be used to indicate a bilateral procedure.
3. -51 (Multiple Procedures): This modifier is used when multiple procedures other than E/M services are performed at the same session by the same provider. It may be necessary if glaucoma surgery is performed alongside another distinct procedure.
4. -59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be applicable if glaucoma surgery (66155) is performed in conjunction with other surgeries or treatments that are not normally reported together.
5. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If the glaucoma surgery is performed during the postoperative period of another unrelated procedure, this modifier would be necessary to indicate that the surgery is not related to the previous procedure’s aftercare.
6. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): If an evaluation and management service is performed during the postoperative period of the glaucoma surgery and is not related to the surgery’s aftercare, this modifier should be used.
These modifiers help clarify the specific circumstances of the surgery and ensure appropriate billing and reimbursement from insurance providers. It's important for healthcare providers to accurately apply these modifiers based on the specific details of the surgical event and associated care.
CPT code 66155, which pertains to glaucoma surgery, specifically a trabeculotomy ab externo, is generally reimbursed by Medicare. However, the actual reimbursement amount 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 CMS (Centers for Medicare & Medicaid Services) website. This tool provides detailed information about 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 additional modifiers needed to optimize the reimbursement process for 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 66155 for glaucoma surgery, 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 billed.
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