CPT code 67346 is a medical code for the procedure of biopsying eye muscle.
CPT code 67346 is designated for a procedure involving the biopsy of an eye muscle. This code is used to bill and document a medical procedure where a small sample of muscle tissue from around the eye is removed for diagnostic analysis. This is typically done to investigate abnormalities or diseases affecting the eye muscles.
For the CPT code 67346, which pertains to a biopsy of the 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 (the part of the procedure performed by the physician) is being billed because the facility or equipment used is not owned by the physician.
2. -50 Bilateral Procedure: If the biopsy is performed on muscles of 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. It helps in adjusting the reimbursement for the additional procedures, which are generally paid at a lower rate.
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 what is typically required.
5. -53 Discontinued Procedure: Use this modifier if the eye muscle biopsy is started but then discontinued due to extenuating circumstances or those that threaten the well-being of the patient during surgery.
6. -54 Surgical Care Only: When only the surgical portion of the procedure is performed by one physician and postoperative care is handled by another, this modifier is appropriate.
7. -55 Postoperative Management Only: This modifier is used when one physician performs the postoperative management but another physician performed the surgical procedure.
8. -56 Preoperative Management Only: If a physician is involved only in the preoperative planning and care but does not perform the surgery, this modifier should be used.
9. -57 Decision for Surgery: This modifier is added when the decision to perform the eye muscle biopsy is made during an evaluation and management service that resulted in the initial decision to perform the surgery.
10. -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.
11. -78 Unplanned Return to the Operating/Procedure Room: Use this modifier if a return to the operating room is required during the postoperative period of the initial procedure to address complications.
12. -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a new procedure (unrelated to the original) is performed by the same physician during the postoperative period.
13. -80 Assistant Surgeon: If another surgeon assists in the biopsy, this modifier is used to indicate their involvement.
14. -AS Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Similar to -80, but specifically for non-physician practitioners assisting in surgery.
Each of these modifiers addresses a specific scenario that might affect billing and should be selected based on the exact circumstances of the eye muscle biopsy procedure. Proper use of these modifiers ensures accurate billing and optimal reimbursement for services rendered.
CPT code 67346, which pertains to a biopsy of the eye muscle, is generally reimbursed 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. an ambulatory surgical center). To determine the exact reimbursement rate, 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). This will provide the most accurate and up-to-date information regarding reimbursement amounts for this specific procedure in your area.
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