CPT code 66991 is for the removal of an intraocular lens during cataract surgery, typically involving one or more incisions.
CPT code 66991 is designated for the procedure involving the removal of an intraocular lens prosthesis during cataract surgery, which includes the insertion of a new intraocular lens. This code is used specifically when the procedure is performed using an endoscope.
For CPT code 66991, which involves extracapsular cataract removal with insertion of an intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), certain 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 indicate which eye the procedure was performed on. Since eye procedures are specific to each eye, using -LT or -RT specifies whether the left or right eye was treated.
2. -50 (Bilateral procedure): If the procedure is performed on both eyes during the same operative session, this modifier should be used. It is important for reimbursement purposes as some payers may adjust the payment for bilateral procedures.
3. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in billing adjustments since the secondary or additional procedures may be reimbursed at a lower rate.
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 can be crucial in cases where procedures that are normally bundled need to be billed separately due to different sessions or surgical sites.
5. -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 if a return to the operating room is required to address a complication or related issue from the initial procedure.
6. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a new procedure, which is not related to the initial procedure, is performed during the postoperative period, this modifier should be applied.
7. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): This is used when an evaluation and management service is performed during the postoperative period for a reason unrelated to the original procedure.
8. -22 (Increased procedural services): When the work required to perform a procedure is substantially greater than typically required, this modifier can be used to indicate that an increased service level was provided.
Each of these modifiers serves a specific purpose in accurately describing the circumstances of the procedure to the payer, ensuring appropriate reimbursement and compliance with billing regulations.
CPT code 66991, which refers to extracapsular cataract removal with insertion of an intraocular lens prosthesis (one stage procedure), is typically reimbursed by Medicare. The reimbursement for this procedure 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 determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions. These resources provide detailed information on the reimbursement rates applicable to different settings and adjustments based on the geographic practice cost indices.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 66991 for extracapsular cataract removal with insertion, RevFind ensures that every payment reflects the contracted rates for each individual payer. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.
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