CPT Code 65820

CPT code 65820 is a medical procedure for relieving inner eye pressure, often used in glaucoma treatment.

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What is CPT Code 65820

CPT code 65820 is a medical procedure code that describes a surgical operation to relieve inner eye pressure, typically performed to treat conditions like glaucoma. This procedure involves creating an opening to drain fluid and reduce pressure within the eye, helping to prevent damage to the optic nerve and maintain vision.

Does CPT 65820 Need a Modifier?

For CPT code 65820, which pertains to the procedure for relieving inner eye pressure (typically associated with glaucoma), 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. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye underwent the procedure. Since eye surgeries are often performed on one eye at a time, it's crucial to indicate the side to ensure proper documentation and billing.

2. -50 (Bilateral procedure): If the procedure is performed on both eyes during the same surgical session, this modifier should be used. It's 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.

4. -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. This can be crucial in cases where procedures that are normally bundled need to be billed separately due to different sessions or surgical sites.

5. -22 (Increased procedural services): If the procedure requires extra work that substantially exceeds the usual service described by the CPT code, this modifier can be applied. Documentation must support the increased effort and complexity.

6. -78 (Unplanned return to the operating/procedure room): This modifier is used when a patient needs to return to the operating room for a related procedure during the postoperative period. It indicates that the return was unplanned and related to the original procedure.

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

8. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): This is applicable if the physician provides an evaluation and management service during the postoperative period that is not related to the original procedure.

Each of these modifiers serves to provide specific details that can affect how a procedure is billed and reimbursed, ensuring that the healthcare provider receives accurate compensation for the services rendered. Proper documentation and justification are essential when using these modifiers to avoid denials and ensure compliance with payer policies.

CPT Code 65820 Medicare Reimbursement

CPT code 65820, which pertains to the procedure for relieving inner eye pressure, typically through a goniotomy or similar surgical method, is generally reimbursed by Medicare. However, the exact reimbursement amount can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (hospital outpatient department vs. an ambulatory surgical center), and the specifics of the patient's Medicare plan.

To determine the precise reimbursement amount for CPT code 65820, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or their local Medicare Administrative Contractor (MAC). These resources provide detailed information on reimbursement rates that are adjusted annually and are specific to each locality.

It is also important for providers to ensure that all documentation and coding are accurately completed to meet Medicare's requirements for medical necessity and compliance, as this can affect whether the procedure is covered and at what rate it is reimbursed.

Are You Being Underpaid for 65820 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 65820 for relieving inner eye pressure, RevFind ensures that each claim is paid correctly according to the terms with individual payers. Schedule a demo today to see how RevFind can safeguard your revenues and streamline your billing processes.

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