CPT code 67220 is a medical billing code for the treatment of a choroid lesion.
CPT code 67220 is used for the treatment of a choroidal lesion. This code is applied when a healthcare provider performs a procedure to treat lesions in the choroid, which is the layer of blood vessels and connective tissue between the sclera and retina in the eye. The treatment can involve various techniques such as photocoagulation, cryotherapy, or thermotherapy, depending on the specific medical requirements of the patient.
For CPT code 67220, which is used for the treatment of a choroid lesion, 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) and -RT (Right side): These modifiers are used to indicate which eye received the treatment. Since choroidal lesions can occur in either eye, specifying the side treated is crucial for accurate billing and medical records.
2. -50 (Bilateral procedure): If the treatment is performed on both eyes during the same operative session, this modifier should be used. It helps in indicating that the procedure was bilateral, which can affect reimbursement.
3. -26 (Professional component): This modifier is used when only the professional component of the procedure (i.e., the service provided by the physician) is being billed because the equipment or facilities were provided by another entity.
4. -TC (Technical component): Conversely, if only the technical component (i.e., the use of equipment and technical staff) is being billed, this modifier should be applied.
5. -22 (Increased procedural services): If the procedure requires significantly more effort or time than typically required, this modifier can be used to indicate an increased level of complexity or effort.
6. -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 relevant if multiple treatments or procedures are performed during a single visit.
7. -76 (Repeat procedure by same physician): If the treatment needs to be repeated in a separate operative session on the same day, this modifier would be appropriate.
8. -79 (Unrelated procedure or service by the same physician during the postoperative period): If the treatment of the choroid lesion occurs during the postoperative period of another unrelated procedure, this modifier would be necessary to indicate the distinction.
Each of these modifiers serves to provide specific details about the treatment that can affect billing and reimbursement. It's important for healthcare providers to accurately apply these modifiers to ensure compliance with billing regulations and to facilitate appropriate payment for services rendered.
CPT code 67220, which pertains to the treatment of a choroid lesion, is typically covered and reimbursed by Medicare, assuming the procedure is deemed medically necessary and the appropriate documentation and conditions are met. The reimbursement for this code can vary based on geographic location, the setting in which the procedure is performed (hospital outpatient department vs. an office), and other factors.
To determine the specific reimbursement amount for CPT code 67220 under Medicare, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates for each CPT code, adjusted for locality and other factors.
Healthcare providers should ensure that all documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement. Additionally, staying updated with any changes in Medicare policies regarding choroid lesion treatments is crucial for maintaining compliance and ensuring accurate billing and coding practices.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and identifying discrepancies down to the CPT code level, including specific codes like 67220 for the treatment of choroid lesions. This precision allows you to ensure that each claim is reimbursed according to the terms of your agreements with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
