CPT Code 65782

CPT code 65782 is a medical billing code for an ocular surface reconstruction, involving a transplant.

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What is CPT Code 65782

CPT code 65782 is designated for an ocular surface reconstruction procedure, specifically involving the transplantation of amniotic membrane to the eye. This procedure is typically used to treat conditions that affect the surface of the eye, such as severe dry eye, chemical burns, or other corneal diseases where the surface of the eye is damaged and requires a biological covering to promote healing and restore function.

Does CPT 65782 Need a Modifier?

For CPT code 65782, which pertains to ocular surface reconstruction using a cellular or tissue-based product, several modifiers may be applicable depending on the specific circumstances of the surgery and billing requirements. 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 substantially greater than typically required. It could be applicable if the ocular reconstruction is unusually complex or time-consuming.

2. -51 (Multiple Procedures): Use this modifier if the ocular surface reconstruction is performed in conjunction with other significant procedures that are not normally bundled together.

3. -52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied.

4. -53 (Discontinued Procedure): Applicable if the procedure is terminated after initiation due to extenuating circumstances or those threatening the well-being of the patient.

5. -54 (Surgical Care Only): When only the surgical portion of the procedure is performed by the reporting physician, this modifier is used.

6. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another performs the surgical procedure.

7. -56 (Preoperative Management Only): This modifier is used when one physician performs the preoperative care and evaluation and another performs the surgery.

8. -58 (Staged or Related Procedure): Use this modifier when the procedure is part of a planned, staged, or related surgical procedure.

9. -59 (Distinct Procedural Service): Indicates that the procedure is not typically bundled with others but is distinct because it is performed independently or at a different session.

10. -78 (Unplanned Return to the Operating/Procedure Room): This modifier is used for a related procedure performed during the postoperative period, which was not planned at the time of the original procedure.

11. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If an unrelated procedure is performed by the same physician during the postoperative period of the original operation, this modifier should be used.

12. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye underwent the procedure.

13. -TC (Technical Component): Used when only the technical portion of the procedure is performed.

14. -26 (Professional Component): Indicates that only the professional component of the procedure is billed when the provider is not responsible for the equipment or facilities used.

Each modifier provides specific information that helps in the accurate processing and reimbursement of claims, ensuring that the services rendered are appropriately compensated. It is crucial to select the correct modifier(s) based on the specific clinical and billing circumstances surrounding each individual case.

CPT Code 65782 Medicare Reimbursement

The CPT code 65782, which refers to ocular surface reconstruction with a cellular or tissue-based product, is reimbursable by Medicare under certain conditions. The reimbursement for this procedure can vary based on the geographic location of the service provider and the specifics of the Medicare plan. It's important for healthcare providers to verify coverage and reimbursement rates directly with Medicare or through their Medicare Administrative Contractor (MAC) to obtain the most accurate and up-to-date information. Additionally, documentation of medical necessity and adherence to Medicare's coverage guidelines are crucial for ensuring reimbursement for this procedure.

Are You Being Underpaid for 65782 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 the CPT code level, including specific codes like 65782 for ocular reconstructive transplantation, RevFind ensures that each claim with individual payers is thoroughly analyzed and compensated correctly. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.

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