CPT Code 65235

CPT code 65235 is used to bill for the removal of a foreign body from the eye by a healthcare provider.

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What is CPT Code 65235

CPT code 65235 is designated for the procedure of removing a foreign body from the eye, specifically when the foreign body is embedded in the cornea or conjunctiva and requires surgical intervention for removal. This code is used by healthcare providers to bill and document this specific ophthalmological procedure.

Does CPT 65235 Need a Modifier?

For the CPT code 65235, which pertains to the removal of a foreign body from the eye, 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. -RT (Right Side) or -LT (Left Side): These modifiers are used to specify which eye underwent the procedure. This is crucial for accurate billing and medical records, as treatments can differ between eyes.

2. -50 (Bilateral Procedure): If the procedure was performed on both eyes during the same operative session, this modifier should be used. It indicates that the service was bilateral, which can affect reimbursement.

3. -51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in adjusting the reimbursement rates for the additional procedures, which are generally paid at a lower rate than the primary procedure.

4. -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 necessary if the removal of the foreign body was performed in conjunction with another, separate procedure.

5. -76 (Repeat Procedure by Same Physician): If the same physician had to repeat the foreign body removal during the same session due to complications or incomplete removal, this modifier would be appropriate.

6. -78 (Unplanned Return to the Operating/Procedure Room): Used if the patient had to return to the operating or procedure room for a related procedure during the postoperative period. This might be applicable if complications arose necessitating further intervention.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If another procedure, unrelated to the foreign body removal, was performed by the same physician during the postoperative period, this modifier would be used.

Each of these modifiers serves to provide clear, specific information that can affect billing and reimbursement. It's important for healthcare providers to use these appropriately to ensure compliance and accurate payment for services rendered.

CPT Code 65235 Medicare Reimbursement

CPT code 65235, which pertains to the removal of a foreign body from the eye, 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 (e.g., hospital outpatient department, physician's office), and the Medicare Administrative Contractor (MAC) policies for that region.

To determine the exact reimbursement amount for CPT code 65235, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on the reimbursement rates for specific procedures based on the provider's locality. Additionally, it's important for providers to verify coverage and any specific documentation requirements with their local MAC to ensure compliance and proper reimbursement.

Are You Being Underpaid for 65235 CPT Code?

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