CPT Code 65280

CPT code 65280 is a medical billing code for the surgical repair of an eye wound.

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What is CPT Code 65280

CPT code 65280 is designated for the surgical procedure involving the repair of a wound in the eye. This code is used specifically when billing for the medical services provided to close and heal a laceration or injury to the eyeball, ensuring proper documentation and reimbursement for the healthcare provider performing the procedure.

Does CPT 65280 Need a Modifier?

For the CPT code 65280, which pertains to the repair of an eye wound, 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. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye underwent the procedure, essential for clarity in billing and medical records.

2. -50 (Bilateral procedure): If the repair involves both eyes during the same operative session, this modifier should be used to indicate a bilateral procedure.

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

4. -59 (Distinct procedural service): This modifier indicates that the procedure was distinct or independent from other services performed on the same day. It is crucial for preventing unbundling and ensuring appropriate payment.

5. -76 (Repeat procedure by same physician): If the same physician needs to repeat the eye wound repair during the same session due to unforeseen circumstances, this modifier would be applicable.

6. -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 the patient must return for another procedure related to the initial repair within the global period.

7. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a new procedure, which is unrelated to the eye wound repair, is performed by the same physician during the postoperative period, this modifier should be used.

8. -22 (Increased procedural services): When the work required to repair the eye wound exceeds the usual range of complexity, this modifier can be added to indicate that the procedure was more labor-intensive than typically expected.

Each of these modifiers serves to provide specific, necessary details that affect how the procedure is billed and reimbursed, ensuring accuracy and compliance in medical billing.

CPT Code 65280 Medicare Reimbursement

The CPT code 65280, which pertains to the repair of an eye wound, is generally reimbursable by Medicare. However, the exact reimbursement amount can vary based on several factors including the geographic location where the service is provided, the setting (such as inpatient or outpatient), and the specifics of the Medicare plan.

To determine the precise reimbursement amount for CPT code 65280, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes based on the locality adjustments.

Additionally, it's important for providers to ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement from Medicare. Proper coding and adherence to Medicare guidelines are essential to optimize revenue cycle management for services involving CPT code 65280.

Are You Being Underpaid for 65280 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 65280 for repair of eye wound, RevFind ensures that each claim is fully compensated according to the terms agreed with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to, ensuring no detail, no matter how small, is overlooked.

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