CPT Code 65765

CPT code 65765 is a medical billing code for the surgical revision of the cornea.

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What is CPT Code 65765

CPT code 65765 is designated for a surgical procedure involving the revision of the cornea. This typically refers to a keratoplasty procedure, specifically a keratophakia or epikeratophakia, which are techniques used to reshape the cornea to correct refractive errors and improve vision.

Does CPT 65765 Need a Modifier?

For CPT code 65765, which pertains to the surgical procedure of keratophakia (corneal revision), 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 used to indicate which eye underwent the procedure. Since eye surgeries are specific to each eye, specifying the side is crucial for accurate billing and medical records.

2. -50 (Bilateral Procedure): If the procedure is performed on both eyes during the same surgical session, this modifier should be used. It is important for reimbursement purposes as some payers may adjust the payment for bilateral procedures.

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

4. -22 (Increased Procedural Services): If the surgery requires extra work that substantially exceeds the usual service described by the CPT code, this modifier can be applied. Documentation must support the additional work and complexity.

5. -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 is crucial for preventing the bundling of procedures and ensuring appropriate reimbursement.

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 a second procedure is needed after the initial surgery due to complications or other related reasons within the postoperative period.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If a new procedure, which is not related to the initial surgery, is performed during the postoperative period, this modifier should be used.

8. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): This modifier is applicable if an evaluation and management service is performed during the postoperative period that is not related to the original procedure.

9. -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Use this modifier when an E/M service is provided on the same day as the procedure, and it is significant and separately identifiable from the procedure itself.

10. -62 (Two Surgeons): When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should use this modifier.

11. -66 (Surgical Team): Used when multiple surgeons (more than two) are required to perform a complex procedure as a team.

12. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a PA, NP, or CNS assists during the surgery.

Each of these modifiers addresses specific billing and procedural nuances that can affect reimbursement and compliance. Proper documentation and justification are essential when applying any modifiers to ensure compliance with payer policies.

CPT Code 65765 Medicare Reimbursement

CPT code 65765, which pertains to the surgical procedure for keratophakia (corneal revision), is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on geographic location, the facility or setting where the procedure is performed, and other factors such as the patient's specific Medicare plan details.

To determine the exact reimbursement amount for CPT code 65765, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through Medicare Administrative Contractors (MACs) that manage Medicare claims and payments in specific regions. These resources provide detailed information on reimbursement rates, which are adjusted annually and may be subject to regional adjustments known as Geographic Practice Cost Indices (GPCIs).

Healthcare providers should also verify coverage and pre-authorization requirements with Medicare or the specific Medicare Advantage plan, as these factors can influence both eligibility for reimbursement and the amount reimbursed.

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