CPT code 67400 is for the exploration or biopsy of the eye socket.
CPT code 67400 is designated for a procedure involving the exploration or biopsy of the eye socket. This code is used when a healthcare provider performs a diagnostic examination, which may include taking a tissue sample (biopsy), of the orbital contents excluding the eyeball itself. This procedure helps in diagnosing conditions or abnormalities within the eye socket.
For the CPT code 67400 (Exploration/biopsy of the eye socket), 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. -22 (Increased Procedural Services): This modifier is used when the service provided is significantly greater than typically required. For example, if the exploration or biopsy involves extensive adhesions or complications that require significantly more time or effort than usual.
2. -50 (Bilateral Procedure): If the exploration or biopsy is performed on both eye sockets during the same operative session, this modifier should be used to indicate a bilateral procedure.
3. -51 (Multiple Procedures): Used when multiple procedures other than E/M services are performed at the same session by the same provider. For example, if another distinct procedure is performed on the eye in addition to the exploration/biopsy.
4. -52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician’s discretion. For instance, if only a limited exploration is performed without a full biopsy.
5. -53 (Discontinued Procedure): Applied when a surgical or diagnostic procedure is terminated after the beginning of the procedure due to extenuating circumstances or those that threaten the well-being of the patient.
6. -54 (Surgical Care Only): When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, this modifier is used by the surgeon.
7. -55 (Postoperative Management Only): Used by a physician who provides postoperative management but did not perform the surgical procedure.
8. -56 (Preoperative Management Only): Used when one physician performs the preoperative care and evaluation and another performs the surgical procedure.
9. -57 (Decision for Surgery): Added to the CPT code when the decision to perform the major surgical procedure is made during an E/M service that occurs a day before or the day of the major surgery.
10. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to indicate that a procedure or service was separate and necessary at the time of surgery.
11. -76 (Repeat Procedure by Same Physician): Used if the same physician needs to repeat a procedure on the same day or during the postoperative period.
12. -78 (Unplanned Return to the Operating/Procedure Room): Used when a patient returns to the operating or procedure room for a related procedure during the postoperative period.
13. -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 procedure) is performed by the same physician during the postoperative period.
14. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye socket is being explored or biopsied.
15. -AS (Assistant Surgeon): Used when an assistant surgeon is present during the procedure.
Each of these modifiers addresses specific circumstances that might affect billing and should be selected based on the details of the surgical event and the roles of the healthcare providers involved.
CPT code 67400, which pertains to the exploration or biopsy of the eye socket, is generally reimbursable by Medicare. However, the specific amount of reimbursement 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 or outpatient), and the Medicare Administrative Contractor (MAC) policies that apply to the region.
To determine the exact reimbursement amount for CPT code 67400, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. This will provide the most accurate and up-to-date information regarding reimbursement rates for their specific area and circumstances. Additionally, it's important to ensure that all documentation and coding are accurately completed to meet Medicare's requirements for reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 67400 for eye socket biopsy procedures, RevFind ensures that every service rendered is appropriately compensated by individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.
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