CPT Code 66635

CPT code 66635 is for the surgical procedure involving the removal of the iris.

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What is CPT Code 66635

CPT code 66635 is designated for the surgical procedure involving the removal of the iris, which is the colored part of the eye surrounding the pupil. This code is used specifically when billing for this type of ophthalmic surgery.

Does CPT 66635 Need a Modifier?

For CPT code 66635, which pertains to the removal of the iris, 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 work required to perform the surgery is substantially greater than typically required. This could be due to extensive adhesions or other complications.

2. -50 (Bilateral Procedure): If the iris removal is performed on both eyes during the same operative session, this modifier should be applied to indicate a bilateral procedure.

3. -51 (Multiple Procedures): Used when multiple procedures other than E/M services are performed at the same session by the same provider. For example, if iris removal is performed along with another distinct procedure.

4. -52 (Reduced Services): Indicates that the surgery was reduced in scope from what was originally planned. This might be used if only a part of the iris needed to be removed.

5. -53 (Discontinued Procedure): Applied when a procedure is terminated after the patient has been prepared for surgery but before the actual surgery. Reasons might include patient safety concerns.

6. -54 (Surgical Care Only): When one physician performs the surgery and another provides preoperative and/or postoperative management.

7. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.

8. -56 (Preoperative Management Only): Indicates that a physician performed the preoperative care only, and another physician performed the surgery.

9. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a staged or related procedure is performed during the postoperative period of the initial procedure.

10. -59 (Distinct Procedural Service): Indicates that procedures that are normally bundled together are provided in different circumstances and should be billed separately.

11. -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 when a return to the operating room is required to address a complication from the initial procedure.

12. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a new procedure is performed by the same physician during the postoperative period of the previous procedure, which is unrelated to the initial procedure.

13. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye underwent the procedure if only one eye was involved.

Each of these modifiers addresses specific circumstances surrounding the surgical procedure, ensuring accurate billing and appropriate reimbursement for the services provided.

CPT Code 66635 Medicare Reimbursement

CPT code 66635, which pertains to the removal of the iris, is generally a reimbursable procedure under Medicare, provided that the procedure is medically necessary and not performed for cosmetic reasons. The reimbursement for this code can vary based on geographic location, the setting in which the procedure is performed (inpatient vs. outpatient), and other factors.

To determine the specific reimbursement amount for CPT code 66635, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for services covered by Medicare. It's important to check the latest updates or modifications in the fee schedule, as Medicare reimbursement rates can be subject to annual adjustments.

Additionally, providers should ensure that all documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement. Prior authorization may be required in some cases, depending on the Medicare Administrative Contractor (MAC) policies governing the specific region.

Are You Being Underpaid for 66635 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 66635 for the removal of iris, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure billed.

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