CPT Code 66820

CPT code 66820 is for the surgical removal of a secondary cataract, enhancing vision post initial cataract surgery.

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What is CPT Code 66820

CPT code 66820 is used to denote a surgical procedure specifically for the incision of a secondary cataract. This procedure involves making an incision to remove the cloudy lens that can develop after cataract surgery, often referred to as a secondary cataract or posterior capsule opacification. This code is utilized when billing for the surgical intervention required to restore clarity of vision following the initial cataract removal.

Does CPT 66820 Need a Modifier?

For CPT code 66820, which pertains to the incision of a secondary cataract (also known as a capsulotomy), 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. -RT (Right Side) and -LT (Left Side): These modifiers are used to indicate which eye underwent the procedure. Since procedures on the eyes are specific to each side, using -RT or -LT specifies whether the right or left eye was treated.

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 to check with individual payer policies as some may require the procedure to be billed on two separate lines with -RT and -LT instead of using -50.

3. -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 the patient needs to return to the operating room for a related procedure that was not planned at the time of the initial surgery.

4. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If a new procedure, which is not related to the capsulotomy, is performed during the postoperative period, this modifier should be applied.

5. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): If the physician provides an unrelated evaluation and management service during the postoperative period of the capsulotomy, this modifier would be necessary.

6. -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 might be applicable if another procedure on the eye is performed during the same session but is not typically bundled with a capsulotomy.

7. -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): If an evaluation and management service is performed on the same day as the capsulotomy and is significant and separately identifiable from the procedure, this modifier should be used.

Each of these modifiers serves to provide clear, specific information to insurers about the circumstances under which the procedure was performed, which is crucial for appropriate reimbursement. Always verify with specific payer guidelines as modifier usage can vary.

CPT Code 66820 Medicare Reimbursement

CPT code 66820, which describes the procedure for the incision of a secondary cataract (also known as a posterior capsulotomy), is typically reimbursed by Medicare. This procedure is commonly required when there is opacification of the posterior capsule following cataract surgery, which can impair vision.

The reimbursement for CPT code 66820 by Medicare can vary based on geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, ambulatory surgical center, or physician's office). To determine the specific reimbursement amount, 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 claims and payments in specific regions.

It's important for healthcare providers to ensure that the documentation clearly supports the medical necessity of the procedure, as this is a key factor in securing reimbursement. Additionally, providers should be aware of any updates to Medicare policies regarding this procedure to ensure compliance and proper billing.

Are You Being Underpaid for 66820 CPT Code?

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