CPT code 67115 is a medical procedure code for releasing encircling material in the eye.
CPT code 67115 is used to describe a surgical procedure specifically focused on the release of encircling material from the eye. This typically involves the removal of a constrictive band of material around the eyeball, which may be impairing the eye's function or health. This code ensures that healthcare providers can accurately document and bill for this specific ophthalmic procedure.
CPT code 67115, which pertains to the surgical procedure for the release of encircling material, may require the use of specific modifiers to accurately represent the circumstances under which the procedure was performed. Below is an ordered list of applicable modifiers and the reasons for their use:
1. -LT (Left Side): Used to indicate that the procedure was performed on the left eye.
2. -RT (Right Side): Used to indicate that the procedure was performed on the right eye.
3. -50 (Bilateral Procedure): Applied when the procedure is performed on both eyes during the same surgical session.
4. -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 the patient needs to return to the operating room for a related procedure that was not planned at the time of the initial surgery.
5. -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, is performed during the postoperative period.
6. -22 (Increased Procedural Services): Indicates that the work performed was substantially greater than typically required for the listed procedure.
7. -23 (Unusual Anesthesia): Occasionally, this procedure might require unusual anesthesia; this modifier would be used to indicate that circumstance.
These modifiers help ensure precise billing and appropriate reimbursement for the services provided, reflecting any special circumstances that might affect the procedural workflow or billing process.
CPT code 67115, which pertains to the procedure of releasing encircling material from the eye, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on geographic location, the setting in which the procedure is performed (such as inpatient vs. outpatient), and the Medicare Administrative Contractor (MAC) policies that apply to the region where the service is provided.
To determine the exact reimbursement amount for CPT code 67115, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on reimbursement rates based on the specific locality. Additionally, it's important for providers to verify coverage and payment details with their local MAC, as there may be specific documentation requirements or limitations on coverage depending on the clinical circumstances surrounding the 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 67115 for the release of encircling material, 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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