CPT code 67345 is a medical procedure code for the destruction of an eye muscle nerve.
CPT code 67345 is used to denote a medical procedure that involves the destruction of a nerve supplying an eye muscle. This procedure is typically performed to address issues related to abnormal eye movements or certain types of eye muscle spasms.
For the CPT code 67345, which involves the destruction of the nerve of an eye muscle, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:
1. -26 Professional Component: This modifier is used when only the professional component of the procedure is being billed because the provider is not responsible for the facility or equipment used.
2. -50 Bilateral Procedure: If the procedure is performed on both eyes during the same operative session, this modifier should be used to indicate a bilateral procedure.
3. -51 Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session by the same provider. It helps in adjusting the reimbursement rates for the additional procedures.
4. -52 Reduced Services: If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied to indicate that the service provided was less than usually required.
5. -53 Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to unforeseen circumstances that made completion of the procedure unsafe.
6. -54 Surgical Care Only: When only the surgical portion of the procedure is performed and postoperative management is handled by another provider, this modifier is applicable.
7. -55 Postoperative Management Only: This modifier is used when the provider is only responsible for the postoperative management of the patient, and another provider performed the surgical procedure.
8. -56 Preoperative Management Only: If the provider only performed the preoperative care and another provider performed the surgery, this modifier should be used.
9. -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.
10. -78 Unplanned Return to the Operating/Procedure Room: This modifier is used when a patient needs to return to the operating or procedure room for a related procedure during the postoperative period.
11. -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If a completely unrelated procedure is performed by the same physician during the postoperative period of the initial procedure, this modifier should be applied.
12. -LT Left Side: Indicates that the procedure was performed on the left eye.
13. -RT Right Side: Indicates that the procedure was performed on the right eye.
Each modifier has specific billing implications and requirements, so it's important to choose the correct modifier(s) based on the specific details of how and where the procedure was performed.
CPT code 67345, which pertains to the destruction of the nerve of an eye muscle, is a procedure that can be covered by Medicare under specific circumstances. The reimbursement for this code, however, can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (such as inpatient vs. outpatient), and the Medicare administrative contractor governing the region.
To determine the exact reimbursement amount for CPT code 67345, it is advisable for healthcare providers to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the CMS (Centers for Medicare & Medicaid Services) website. This tool provides detailed information about the reimbursement rates applicable to different procedures in various regions.
Additionally, providers should ensure that the procedure is medically necessary and properly documented in the patient's medical records to facilitate approval and reimbursement by Medicare. It's also crucial to check for any updates or changes in Medicare policies regarding this specific CPT code, as these can influence coverage and payment.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind meticulously reads through your contracts and pinpoints underpayments at the detailed level of each CPT code, including specific ones like 67345 for the destruction of eye muscle nerve procedures. By analyzing discrepancies by individual payer, RevFind ensures that no payment slips through the cracks. Schedule a demo today to see how RevFind can help secure the payments you are rightfully owed.
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
