CPT Code 65110

CPT code 65110 is a medical billing code for the surgical removal of an eye.

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What is CPT Code 65110

CPT code 65110 is designated for the surgical procedure involving the removal of an eye, medically known as enucleation. This procedure is typically performed to address severe injuries, tumors, or infections that cannot be treated through less invasive methods.

Does CPT 65110 Need a Modifier?

For CPT code 65110, which pertains to the removal of an eye (enucleation), several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side) and -RT (Right side): These modifiers are crucial for specifying which eye was removed, as procedures involving organs or structures that exist on both sides of the body require clarification.

2. -50 (Bilateral procedure): This modifier is used if the procedure was performed on both eyes during the same operative session. It is important to check payer policies as some may not accept this modifier for certain procedures or may have specific billing rules.

3. -22 (Increased procedural services): This modifier can be used if the procedure requires significantly more effort or time than typically required. Documentation must support the extra work and reason.

4. -52 (Reduced services): If the procedure was partially reduced or altered as per the physician’s discretion, this modifier would be appropriate. Documentation should clearly justify why the procedure was reduced.

5. -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 if complications require a return to the operating room.

6. -79 (Unrelated procedure or service by the same physician during the postoperative period): If another procedure, unrelated to the eye removal, is performed during the postoperative period, this modifier should be used.

7. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If the physician provides an unrelated E/M service during the postoperative period, this modifier is applicable.

8. -23 (Unusual anesthesia): Occasionally, if unusual anesthesia is required for the procedure, this modifier would be appropriate.

9. -59 (Distinct procedural service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This can be crucial in situations where multiple procedures are performed.

10. -62 (Two surgeons): When two surgeons are required to perform the procedure, each performing distinct parts, this modifier is used.

Each modifier has specific documentation requirements and implications for billing and reimbursement. It is essential to consult with the payer or review the payer’s policy to ensure correct usage and compliance with billing regulations.

CPT Code 65110 Medicare Reimbursement

CPT code 65110, which pertains to the removal of an eye (enucleation), is generally reimbursed 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 (hospital outpatient department vs. ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for the region.

To determine the exact reimbursement amount, it is advisable for healthcare providers to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information about the reimbursement rates for specific CPT codes based on the locality. Additionally, providers should also verify coverage and payment details with their local MAC to ensure compliance with any specific documentation or procedural requirements that may affect the reimbursement for this procedure.

Are You Being Underpaid for 65110 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific procedures like CPT 65110 - Removal of eye. Schedule a demo today to see how RevFind can help you secure correct payments from each payer, ensuring your financial operations are as efficient and accurate as possible.

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