CPT Code 67105

CPT code 67105 is a medical billing code for the procedure of repairing a detached retina using photocoagulation.

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What is CPT Code 67105

CPT code 67105 is used to denote a medical procedure involving the repair of a detached retina using photocoagulation, which is a technique that employs laser light to create burns around the retinal tear. This process helps to seal the retina to the underlying tissue, preventing further detachment. This code specifically applies to the procedure when performed on one eye, without the use of extensive scleral buckling (a surgical method that involves indenting the wall of the eye).

Does CPT 67105 Need a Modifier?

For the CPT code 67105, which pertains to the procedure for repairing a detached retina via photocoagulation, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. 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 indicate which eye underwent the procedure. Since retinal repairs are specific to each eye, specifying the side is crucial for accurate billing and medical records.

2. -50 (Bilateral procedure): If the procedure was performed on both eyes during the same operative session, this modifier should be used. It often affects reimbursement rates, as some payers may not pay 100% for both procedures.

3. -51 (Multiple procedures): This modifier is used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider. It may be necessary if other procedures besides 67105 are performed simultaneously.

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 applicable if 67105 is performed in conjunction with other, non-related procedures that are not normally reported together.

5. -79 (Unrelated procedure or service by the same physician during the postoperative period): If the retinal repair is performed during the postoperative period of another unrelated procedure, this modifier would be necessary to indicate that the procedures are not connected.

6. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If an evaluation and management service is performed during the postoperative period of the initial procedure and it is not related to the original procedure’s aftercare, this modifier should be used.

7. -78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period): If a return to the operating room is required for a reason related to the original procedure (e.g., complications), this modifier would be appropriate.

Each of these modifiers serves to provide clear, specific information that can affect billing and reimbursement. It is essential for healthcare providers to use these modifiers correctly to ensure compliance with billing regulations and to secure appropriate payment for services rendered.

CPT Code 67105 Medicare Reimbursement

CPT code 67105, which pertains to the procedure for repairing a detached retina via photocoagulation, is generally reimbursed by Medicare. The reimbursement for this procedure can vary based on the geographic location and the setting in which the service is provided (e.g., hospital outpatient department versus an ambulatory surgical center).

To determine the specific reimbursement amount, you would need to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions. These resources provide detailed information on the reimbursement rates applicable to different settings and localities.

It's also important to note that reimbursement can be affected by multiple factors including the use of modifiers, the patient's specific Medicare plan, and whether the provider meets certain billing criteria set by Medicare. Always ensure that billing and coding practices align with the latest Medicare guidelines to optimize reimbursement.

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