CPT code 66185 is for revising an aqueous shunt in the eye to manage glaucoma.
CPT code 66185 is designated for the revision of an aqueous shunt to an extraocular reservoir in the eye. This procedure involves adjusting or repairing an existing shunt, which is used to help drain fluid and manage intraocular pressure in patients with conditions like glaucoma. The revision may be necessary if the original shunt is malfunctioning or causing complications.
For the CPT code 66185, which pertains to the revision of an aqueous shunt to an extraocular reservoir, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of potential modifiers and the reasons for their use:
1. -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the revision of the aqueous shunt is planned or anticipated (staged) or more extensive than the original procedure, and it occurs during the postoperative period of the first surgery.
2. -78 Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the revision is unplanned and requires a return to the operating room due to complications or other related reasons during the postoperative period.
3. -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be applied if the revision of the aqueous shunt is unrelated to the original procedure and occurs during the postoperative period.
4. -76 Repeat Procedure by Same Physician: This modifier can be used if the same physician performs a repeat of the revision procedure on the aqueous shunt.
5. -77 Repeat Procedure by Another Physician: Use this modifier if a different physician performs the revision procedure on the aqueous shunt.
6. -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: If, on the day of the aqueous shunt revision, the patient requires a significant, separately identifiable E/M service, this modifier should be added.
7. -59 Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
8. -50 Bilateral Procedure: If the revision procedure is performed on both eyes during the same session, this modifier should be used.
9. -LT Left Side and -RT Right Side: These modifiers are used to specify which eye underwent the revision procedure if only one eye is involved.
10. -51 Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session.
11. -22 Increased Procedural Services: When the work required to perform the revision significantly exceeds the usual range of complexity, this modifier may be applied.
Each modifier has specific guidelines for use, and it's important to ensure compliance with payer policies when applying these modifiers to ensure proper reimbursement for the services provided.
CPT code 66185, which pertains to the revision of an aqueous shunt to an extraocular reservoir in the eye, is typically reimbursed by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the Medicare Administrative Contractor (MAC) policies in effect in that region. It's important for healthcare providers to verify the coverage specifics and reimbursement rates in their specific area by consulting the local MAC or using the Medicare Physician Fee Schedule Look-Up Tool available on the CMS (Centers for Medicare & Medicaid Services) website. This tool provides detailed information about the reimbursement rates applicable to different procedures 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 66185 for revising an aqueous shunt in the eye, RevFind ensures that each claim is paid correctly according to the terms agreed with individual payers. 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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