CPT Code 65750

CPT code 65750 is a medical billing code for a corneal transplant procedure.

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What is CPT Code 65750

CPT code 65750 is designated for a corneal transplant procedure, specifically referring to the surgical replacement of the cornea, the clear front part of the eye, with a donor cornea. This procedure is medically known as penetrating keratoplasty.

Does CPT 65750 Need a Modifier?

For CPT code 65750, which pertains to a corneal transplant, several modifiers may be applicable depending on the specific circumstances of the surgery and billing context. 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 indicate which eye received the transplant. Since procedures involving organs that come in pairs need specification, these modifiers are crucial for accurate billing.

2. -50 (Bilateral procedure): If the corneal transplant is performed on both eyes during the same surgical session, this modifier should be used. It helps in indicating that the procedure 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 may be applicable if the corneal transplant is done alongside another distinct procedure.

4. -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 a return to surgery is required for a reason related to the original procedure, such as complications or adjustments.

5. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a new procedure, which is not related to the corneal transplant, is performed during the postoperative period, this modifier would be necessary.

6. -22 (Increased procedural services): When the work required to perform the corneal transplant is substantially greater than typically required, this modifier can be used to indicate that the procedure was more complex or time-consuming than usual.

7. -23 (Unusual anesthesia): Occasionally, if a procedure requires unusual anesthesia, this modifier is applicable. For a corneal transplant, if anesthesia other than typical local or topical is used, this modifier might be relevant.

8. -24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period): This is used if the physician provides an E/M service during the postoperative period that is not related to the corneal transplant.

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. It might be applicable if other, separate treatments or diagnostics are performed during the transplant session.

10. -76 (Repeat procedure by the same physician): If the corneal transplant needs to be repeated by the same physician, this modifier would be used to indicate a repeat procedure.

Each of these modifiers serves to provide clear, specific information that can affect billing and reimbursement, ensuring that the healthcare provider's billing practices align with regulatory requirements and payer policies.

CPT Code 65750 Medicare Reimbursement

CPT code 65750, which pertains to a corneal transplant, is generally reimbursed by Medicare. This procedure falls under the category of medically necessary treatments, which Medicare covers. The specific amount of reimbursement can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, the facility where the procedure is performed, and other factors such as whether it is performed in an inpatient or outpatient setting.

To determine the exact reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) or contact the local MAC. These sources provide detailed information on the reimbursement rates applicable to specific geographic areas and settings. 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 65750 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 65750 for corneal transplants, RevFind ensures that each claim with individual payers is fully compensated. Schedule a demo today to see how RevFind can safeguard your earnings and streamline your billing processes.

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