CPT code 66987 is for the removal of a complex cataract with an intraocular lens implant using extra capsular techniques.
CPT code 66987 is for the surgical procedure involving the removal of a complex cataract with the insertion of an intraocular lens prosthesis. This procedure includes the use of an endoscopic cyclophotocoagulation (ECP), a technique used to treat the ciliary body of the eye to reduce intraocular pressure, typically in cases where the cataract is causing vision issues and other complications.
For CPT code 66987, which involves complex cataract surgery with the use of an endocapsular ring, 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) and -RT (Right side): These modifiers are used to specify which eye underwent the procedure, as cataract surgery is typically performed on one eye at a time.
2. -50 (Bilateral procedure): This modifier is used if the procedure is performed on both eyes during the same surgical session. It's important to check payer policies as some may not allow bilateral billing for this procedure or may require it to be billed on separate lines.
3. -22 (Increased procedural services): This modifier can be used if the service provided is more extensive than usually required. This might be applicable if there are complications or additional steps needed beyond the typical scope of a complex cataract surgery.
4. -51 (Multiple procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement rates for the additional procedures.
5. -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 crucial for preventing the bundling of procedures and ensuring appropriate reimbursement.
6. -78 (Unplanned return to the operating room): Used if a return to the operating room is required during the postoperative period of the initial surgery due to complications. This modifier helps in differentiating the stages of care and justifying the additional service.
7. -79 (Unrelated procedure or service by the same physician during the postoperative period): This is applicable if another procedure, unrelated to the cataract surgery, is performed during the postoperative period.
8. -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 surgery, this modifier would be appropriate.
Each of these modifiers addresses specific billing circumstances and helps ensure that the healthcare provider receives appropriate compensation for the services rendered. It's essential to use these modifiers correctly to comply with payer requirements and avoid claims denials.
CPT code 66987, which refers to 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, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorhexis) or performed on patients in the amblyogenic developmental stage, is reimbursed by Medicare.
The reimbursement for CPT code 66987 can vary based on geographic location and the setting in which the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center). To find the specific reimbursement amount, it is recommended to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website or contact a local Medicare administrator. The reimbursement amount is subject to change annually based on updates in Medicare policies and fee schedules.
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