CPT Code 65290

CPT code 65290 is for the surgical repair of an eye socket wound.

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What is CPT Code 65290

CPT code 65290 is designated for the surgical repair of a wound in the eye socket. This procedure involves addressing injuries to the structures within the orbital area, which may include the eyelids, tear ducts, and other surrounding tissues. The code is used for billing and documentation purposes in healthcare settings to specify this particular type of ophthalmic surgical repair.

Does CPT 65290 Need a Modifier?

For the CPT code 65290, which pertains to the repair of an eye socket 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. -22 (Increased Procedural Services): This modifier is used when the service provided is significantly greater than typically required. For example, if the repair involves extensive reconstruction due to severe trauma, this modifier would be appropriate.

2. -51 (Multiple Procedures): Use this modifier if the repair of the eye socket wound is performed at the same time as another distinct procedure. This helps in adjusting the reimbursement for multiple procedures that were performed during the same surgical session.

3. -52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied. This might occur if less extensive repair was needed than initially anticipated.

4. -58 (Staged or Related Procedure): This modifier is used when a procedure is performed in stages. If the repair of the eye socket wound is part of a planned, multi-stage treatment, this modifier would be applicable.

5. -59 (Distinct Procedural Service): This modifier indicates that the procedure is not typically bundled with other services but is distinct and separate when performed on the same day. It's used to signify that the procedure is independent from other services performed on the same day.

6. -78 (Unplanned Return to the Operating/Procedure Room): If a return to the operating room is required for a related procedure during the postoperative period, this modifier should be used. It might be applicable if complications arise necessitating further immediate repair.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a new procedure (unrelated to the eye socket repair) is performed by the same physician during the postoperative period.

8. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye socket was repaired if only one side was involved.

Each of these modifiers serves to provide additional information that can affect billing and reimbursement, ensuring that the services rendered are accurately documented and compensated. It's crucial for healthcare providers to select the appropriate modifier(s) based on the specific details of the surgical procedure and any concurrent services provided.

CPT Code 65290 Medicare Reimbursement

CPT code 65290, which pertains to the repair of an eye socket wound, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location where the service is provided, the setting (such as inpatient or outpatient), and the complexity of the procedure.

To determine the exact reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through their regional Medicare administrator. This schedule provides detailed information on the reimbursement rates for specific procedures under Medicare. Additionally, it's important to ensure that all documentation and coding are accurately completed to avoid delays or denials in reimbursement.

Are You Being Underpaid for 65290 CPT Code?

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