CPT CODES

CPT Code 68745

CPT code 68745 is for a surgical procedure to create a tear duct drain.

Table of Contents
What is CPT Code 68745
Does CPT 68745 Need a Modifier?
CPT Code 68745 Medicare Reimbursement
Are You Being Underpaid for 68745 CPT Code?
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What is CPT Code 68745

CPT code 68745 is used to denote a surgical procedure involving the creation of a tear duct drain. This code specifically refers to the medical intervention where a new channel is surgically created to facilitate the drainage of tears when the natural tear ducts are blocked or dysfunctional. This procedure is essential in treating conditions that cause excessive tearing or chronic infections due to poor tear drainage.

Does CPT 68745 Need a Modifier?

For the CPT code 68745 (Create tear duct drain), several modifiers may be applicable depending on the specific circumstances of the surgery and billing guidelines. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side): Indicates that the procedure was performed on the left side of the body. This modifier is necessary when the procedure is specific to one side to ensure accurate billing and documentation.

2. -RT (Right side): Indicates that the procedure was performed on the right side of the body. Like the -LT modifier, it is used for procedures that are side-specific.

3. -50 (Bilateral procedure): Used when the procedure is performed on both sides of the body during the same operative session. It is important for correct reimbursement as some payers may adjust the payment for bilateral procedures.

4. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that this procedure is secondary or subsequent to the primary procedure. This can affect the reimbursement rate for the procedure coded with this modifier.

5. -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 signify that the procedure was separate and necessary at the same session but not bundled with other services.

6. -76 (Repeat procedure by same physician): Used if the procedure needs to be repeated in the same session by the same physician. This can occur in cases where the initial procedure was incomplete or needs correction.

7. -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 used when a return to the operating room is required to address a complication or related issue from the initial procedure.

8. -79 (Unrelated procedure or service by the same physician during the postoperative period): Used when a new procedure, which is not related to the initial procedure, is performed during the postoperative period by the same physician.

Each of these modifiers provides specific information that helps in the accurate processing and reimbursement of claims. It is crucial for healthcare providers to use the correct modifiers to avoid delays or denials in payment.

CPT Code 68745 Medicare Reimbursement

CPT code 68745, which pertains to the creation of a tear duct drain, 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., outpatient hospital, physician's office). It's important for healthcare providers to check the Medicare Physician Fee Schedule (MPFS) for the exact reimbursement rate applicable in their region.

Additionally, providers should ensure that the documentation supports the medical necessity of the procedure, as this is crucial for Medicare coverage. Pre-authorization may also be required in certain cases, depending on the Medicare Administrative Contractor (MAC) policies governing the specific region.

Are You Being Underpaid for 68745 CPT Code?

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