CPT code 67145 is used for billing a procedure to treat retinal detachment.
CPT code 67145 is used to denote a procedural service where a prophylactic treatment is performed to treat a retinal tear using a laser or cryotherapy. This code specifically applies to cases where the detachment of the retina is prevented by creating an adhesion around the retinal break to seal it off and prevent fluid from entering and causing further detachment. This procedure is typically used in patients who are at high risk of retinal detachment, such as those with lattice degeneration or existing retinal tears.
For CPT code 67145, which pertains to the procedure of prophylactic treatment of the retina (e.g., retinal tear, lattice degeneration) with photocoagulation or cryotherapy, several modifiers may be applicable depending on the specific circumstances of the treatment provided. Here is an ordered list of potential modifiers and the reasons for their use:
1. -LT (Left side): Used to specify that the procedure was performed on the left eye.
2. -RT (Right side): Used to specify 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 operative session. It is important to check payer policies as some may require billing each eye separately with -LT and -RT instead of using -50.
4. -79 (Unrelated procedure or service by the same physician during the postoperative period): This modifier is used if the same physician performs a procedure that is not related to the initial procedure during the postoperative period.
5. -58 (Staged or related procedure or service by the same physician during the postoperative period): Used when a staged or related procedure is performed during the postoperative period of the initial procedure.
6. -76 (Repeat procedure by same physician): This modifier is used if the procedure needs to be repeated by the same physician. It can be necessary if the initial treatment was not effective or if additional treatment is required.
7. -77 (Repeat procedure by another physician): Similar to -76, but used when the procedure is repeated by a different physician.
8. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If an unrelated evaluation and management service is needed during the postoperative period, this modifier would be appropriate.
Each modifier serves to provide additional details that affect how the procedure is billed and reimbursed, ensuring accurate claims processing and compliance with payer rules. Always verify with specific payer guidelines as the applicability of modifiers can vary.
CPT code 67145, which pertains to the procedure of prophylactic treatment of retinal detachment (e.g., retinal photocoagulation or cryotherapy), is generally reimbursed by Medicare. The reimbursement for this code can vary based on the geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, physician's office). 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.
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