CPT code 68750 is used for billing the creation of a tear duct drain in medical procedures.
CPT code 68750 is used to describe a surgical procedure involving the creation of a tear duct drain. This procedure is typically performed to address issues with tear drainage, such as blockages or infections, by establishing an alternative pathway for tears to drain from the eye to the nasal cavity. This helps alleviate symptoms associated with poor tear drainage, such as excessive tearing or recurrent eye infections.
For CPT code 68750, which pertains to the creation of a tear duct drain, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of common modifiers that might be used with this code, along with the reasons for each:
1. -22 (Increased Procedural Services): This modifier is used when the work required to perform the surgery is substantially greater than typically required. This could be due to increased complexity, difficulty, or time spent beyond what is usually necessary for the procedure.
2. -50 (Bilateral Procedure): If the procedure is performed on both tear ducts during the same surgical session, this modifier should be applied to indicate that both sides were addressed.
3. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement for multiple procedures to account for reduced resources and time needed to perform subsequent procedures.
4. -52 (Reduced Services): This modifier is applicable if the procedure is partially reduced or eliminated at the physician's discretion. For instance, if only a partial creation of a tear duct drain is needed or possible.
5. -53 (Discontinued Procedure): Applied when a procedure is terminated after the initiation but before completion due to extenuating circumstances or those threatening the well-being of the patient.
6. -54 (Surgical Care Only): When one physician performs the surgical care and another provides preoperative and/or postoperative management, this modifier is used.
7. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.
8. -56 (Preoperative Management Only): Indicates that a physician performed only the preoperative care when another physician performed the surgery.
9. -57 (Decision for Surgery): Added to the CPT code when the decision to perform the surgery was made during an evaluation and management service, typically within 24 hours of the surgery.
10. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a staged or related procedure is performed during the postoperative period of the initial procedure.
11. -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 a procedure is not normally reported together but is appropriate under the circumstances.
12. -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 from the initial procedure.
13. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a new or unrelated procedure is performed by the same physician during the postoperative period of the previous procedure.
14. -80 (Assistant Surgeon): Used when an assistant surgeon is present to help the primary surgeon during the procedure.
15. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used specifically for non-physician practitioners who assist at surgery.
Each of these modifiers addresses specific circumstances surrounding the performance of CPT code 68750, ensuring accurate documentation and appropriate reimbursement for the services provided.
CPT code 68750, which pertains to the creation of a tear duct drain, is generally reimbursed by Medicare. However, the exact reimbursement amount can vary based on the geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, ambulatory surgical center, or physician's office). It's important for healthcare providers to check the Medicare Physician Fee Schedule (MPFS) for specific reimbursement rates applicable to their locality.
To ensure accurate billing and reimbursement, providers should also be aware of any documentation requirements or specific billing guidelines that Medicare may have for this procedure. Additionally, verifying patient eligibility and benefits before performing the procedure can help prevent issues with 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 68750 for creating a tear duct drain, RevFind ensures that each service rendered is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure, including individual payer details. Don't let underpayments go unnoticed—let RevFind safeguard your revenue.
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
