CPT code 67340 is an add-on code for additional eye muscle surgery during the same session.
CPT code 67340 is designated for revision procedures on eye muscles, specifically as an add-on. This code is used when additional work is required on the eye muscles during a surgical session that has already involved primary eye muscle procedures. It is important to note that this code should only be used in conjunction with the primary procedure codes and cannot be billed independently.
CPT code 67340, which pertains to the revision of eye muscle surgery as an add-on procedure, may require the use of specific modifiers to accurately represent the circumstances of the billing scenario. Here’s an ordered list of applicable modifiers and the reasons for their use:
1. -51 Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps to indicate that this procedure is secondary or additional to the primary procedure.
2. -59 Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly relevant if the services are typically bundled but need to be billed separately due to different sessions, surgical sites, or patient encounters.
3. -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 applicable if the revision of eye muscle surgery was unplanned and occurred within the global period of the original surgery.
4. -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the revision procedure is unrelated to the original procedure and occurs within the global period.
5. -80 Assistant Surgeon: If another surgeon assists in the revision surgery, this modifier should be used to indicate their involvement.
6. -XE Separate Encounter: This modifier, part of the X{EPSU} subset, is used to signify that a service that is normally bundled into one payment was performed in a separate encounter on the same day.
7. -XS Separate Structure: This modifier indicates that the procedure was performed on a separate anatomical structure (e.g., different eye).
8. -XP Separate Practitioner: Indicates that a different practitioner performed the services that are normally bundled together.
Each of these modifiers provides specific information that can affect reimbursement and is crucial for proper billing and compliance. It’s important to select the correct modifier based on the specific circumstances of the surgical event and the rules of the payer.
CPT code 67340, which pertains to an add-on procedure for eye muscle surgery, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the setting in which the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center). To determine the exact reimbursement rate, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through your Medicare Administrative Contractor (MAC). This will provide the most accurate and up-to-date information regarding reimbursement for CPT code 67340.
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