CPT code 66982 is for complex cataract surgery without an endocapsular ring.
CPT code 66982 is used to describe a complex cataract surgery without endoscopic cyclophotocoagulation. This code is specifically assigned for cases where the cataract extraction involves additional challenges that require extra surgical skills or techniques, beyond the routine cataract removal. These complexities might include dense or mature cataracts, poor pupil dilation, or other complicating factors that make the surgery more intricate than usual.
For CPT code 66982, which is used for extracapsular cataract removal with insertion of an intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, 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. -LT (Left side) or -RT (Right side): These modifiers are used to specify which eye underwent the procedure, as treatments are often specific to one eye.
2. -50 (Bilateral procedure): If the procedure is performed on both eyes during the same operative session, this modifier should be used. However, it's important to check payer policies as some may require each eye to be billed separately using -LT and -RT.
3. -22 (Increased procedural services): This modifier can be used if the service provided is significantly greater than typically required. Documentation must support the extra work and reason (e.g., severe scarring requiring additional time).
4. -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 for a reason unrelated to the original procedure, this modifier would be appropriate.
5. -54 (Surgical care only): When one physician performs the surgery and another provides preoperative and/or postoperative management, this modifier is used.
6. -55 (Postoperative Management only): Used when one physician performs the postoperative management and another physician performed the surgery.
7. -56 (Preoperative Management only): This modifier is used when one physician performs the preoperative care and another physician performs the surgery.
8. -58 (Staged or related procedure or service by the same physician during the postoperative period): This can be used if a second procedure is performed during the postoperative period that was planned at the time of the first procedure or is more extensive than the original procedure.
9. -59 (Distinct procedural service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to indicate that a procedure is not normally reported together but is appropriate under the circumstances.
10. -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.
11. -79 (Unrelated procedure or service by the same physician during the postoperative period): Used when a new procedure (which is not related to the original procedure) is performed during the postoperative period.
Each of these modifiers serves to provide additional information that can affect reimbursement and is essential for accurate billing and compliance with payer policies. Always ensure that documentation supports the use of any modifiers to avoid denials and audits.
CPT code 66982, which pertains to extracapsular cataract removal with insertion of an intraocular lens prosthesis (one stage procedure), complex, is typically reimbursed by Medicare. The reimbursement for this procedure can vary based on geographic location and the specific Medicare administrative contractor (MAC) policies. However, the national average Medicare payment for CPT code 66982 is approximately $1,036. This figure is a general estimate and can differ based on adjustments such as facility vs. non-facility rates, and any applicable modifiers that might affect the reimbursement rate. Providers should verify the specific reimbursement rates and policies with their local MAC.
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