CPT Code 66852

CPT code 66852 is a medical code for the surgical removal of lens material from the eye.

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What is CPT Code 66852

CPT code 66852 is designated for the surgical procedure involving the removal of lens material that has been left behind or has become problematic, typically following a cataract surgery. This code is used specifically when the removal is done using techniques that do not involve a large incision, such as using aspiration or phacoemulsification methods. This procedure is often necessary when there are complications such as retained lens fragments following the initial cataract removal, which can lead to issues like increased intraocular pressure or inflammation.

Does CPT 66852 Need a Modifier?

For CPT code 66852, which pertains to the removal of lens material, several modifiers may be applicable depending on the specific circumstances of the surgical procedure and billing context. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side) - This modifier is used to indicate that the procedure was performed on the left eye.

2. -RT (Right side) - This modifier is used to indicate that the procedure was performed on the right eye.

3. -50 (Bilateral procedure) - If the procedure was performed on both eyes during the same operative session, this modifier should be used.

4. -51 (Multiple procedures) - This modifier is used when multiple procedures are performed during the same surgical session. It helps in adjusting the reimbursement rates for the additional procedures.

5. -59 (Distinct procedural service) - This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.

6. -78 (Unplanned return to the operating/procedure room) - If a return to the operating room is required for a related procedure during the postoperative period, this modifier is used.

7. -79 (Unrelated procedure or service by the same physician during the postoperative period) - This modifier is applicable if a new procedure, which is unrelated to the original, is performed by the same physician during the postoperative period.

8. -22 (Increased procedural services) - When the work required to perform the surgery is substantially greater than typically required, this modifier may be used to indicate that an increased service level was provided.

Each of these modifiers serves to provide specific details that can affect billing and reimbursement processes, ensuring that the claims are accurately processed according to the nuances of the surgical service provided.

CPT Code 66852 Medicare Reimbursement

CPT code 66852, which pertains to the removal of lens material, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the setting in which the procedure is performed (e.g., hospital outpatient department versus an ambulatory surgical center). To determine the exact reimbursement rate, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your local Medicare Administrative Contractor (MAC). This will provide the most accurate and up-to-date information regarding reimbursement amounts for CPT code 66852.

Are You Being Underpaid for 66852 CPT Code?

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