CPT code 68811 is a medical procedure code for probing the nasolacrimal duct.
CPT code 68811 is used to denote a medical procedure involving the probing of the nasolacrimal duct. This procedure is typically performed to diagnose or treat conditions related to blockages or other issues within the nasolacrimal duct, which is responsible for draining tears from the eyes into the nasal cavity.
For CPT code 68811, which pertains to probing of the nasolacrimal duct, 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. -50 Bilateral Procedure: This modifier is used when the procedure is performed on both sides of the body during the same operative session. It is applicable if the probing is done on both nasolacrimal ducts.
2. -LT Left Side: Indicates that the procedure was performed on the left nasolacrimal duct.
3. -RT Right Side: Indicates that the procedure was performed on the right nasolacrimal duct.
4. -51 Multiple Procedures: Used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.
5. -52 Reduced Services: This modifier is used when the service provided is less than that usually required for the listed procedure. It might be applicable if only a partial probing or a limited procedure was performed.
6. -53 Discontinued Procedure: Applied when a procedure is terminated after the beginning but before completion due to extenuating circumstances or those that threaten the well-being of the patient.
7. -73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia: Similar to -53 but specific to outpatient or ASC settings, indicating that the procedure was discontinued prior to the administration of anesthesia.
8. -74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After the Administration of Anesthesia: Used in outpatient or ASC settings when the procedure is discontinued after anesthesia is administered.
Each modifier provides a way to accurately document the specific circumstances of the procedure, which can affect billing and reimbursement processes. It's important for healthcare providers to select the appropriate modifier(s) to ensure proper claims processing and compliance with payer requirements.
CPT code 68811, which pertains to the probing of the nasolacrimal duct, is generally reimbursed by Medicare. However, the reimbursement can vary based on the specifics of the procedure, the geographic location, and the setting in which the procedure is performed (e.g., outpatient hospital, physician's office).
To determine the exact reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. The MPFS provides detailed information on reimbursement rates for specific procedures based on the locality. Additionally, it's important to ensure that the documentation supports the medical necessity of the procedure, as this is a key factor in Medicare's coverage decisions.
For healthcare providers, staying updated with the MPFS and regularly checking for any changes in coding or reimbursement guidelines is crucial for accurate billing and to avoid potential denials.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 68811 for probing the nasolacrimal duct, RevFind ensures that each claim 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 service rendered.
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