CPT Code 66988

CPT code 66988 is for the removal of an eye's cataract with insertion of an intraocular lens.

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What is CPT Code 66988

CPT code 66988 is used to describe a surgical procedure involving the removal of a cataract with the insertion of an intraocular lens prosthesis. This code specifies that the procedure is done using an endocapsular technique, which involves removing the cataract while leaving the back part of the lens capsule intact, allowing for the placement of the new lens.

Does CPT 66988 Need a Modifier?

CPT code 66988 refers to the surgical procedure for the removal of a cataract with insertion of an intraocular lens prosthesis, accomplished via an endocapsular technique. When billing for this procedure, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of potential modifiers that could be used with CPT code 66988 and the reasons for each:

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 increased difficulty or complications encountered during the procedure.

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

3. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement rates for the additional procedures.

4. -54 (Surgical Care Only): When one physician performs the surgery and another provides preoperative and/or postoperative management, this modifier is used to indicate that only the surgical care was provided.

5. -55 (Postoperative Management Only): This modifier is used when the physician is only responsible for the postoperative management of the patient.

6. -56 (Preoperative Management Only): Used when a physician only provides the preoperative care and does not perform the surgery.

7. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to signify that a procedure is not normally reported together but is appropriate under the circumstances.

8. -78 (Unplanned Return to the Operating/Procedure Room): Used when a return to the operating room is required during the postoperative period of the initial procedure to deal with complications.

9. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a new procedure (unrelated to the original procedure) is performed by the same physician during the postoperative period.

10. -RT (Right Side) and -LT (Left Side): These modifiers are used to indicate which eye the procedure was performed on. This is crucial for clarity in procedures involving organs that come in pairs.

Each of these modifiers serves to provide specific information that affects how billing and payments are processed, ensuring that the services rendered are accurately documented and reimbursed.

CPT Code 66988 Medicare Reimbursement

CPT code 66988, which pertains to extracapsular cataract removal with insertion of an intraocular lens prosthesis (one stage procedure), is typically reimbursed by Medicare. This procedure is commonly performed on elderly patients, a demographic that largely falls under Medicare coverage.

The reimbursement for CPT code 66988 by Medicare can vary based on several factors including geographic location, the setting in which the procedure is performed (hospital outpatient department vs. ambulatory surgical center), and the annual adjustments in Medicare policies and rates.

As of the latest data, the Medicare reimbursement for this code can range significantly. For a more precise figure, it's advisable to check the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or consult with a billing specialist who can provide updated and location-specific reimbursement details. This ensures accuracy in billing and helps in financial planning for healthcare providers.

Are You Being Underpaid for 66988 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 66988 for capsular contracture removal with endocapsular procedures, RevFind ensures that every payment reflects your contracted rates. Schedule a demo today to see how RevFind can meticulously analyze payments for each individual payer and safeguard your financial interests.

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