CPT Code 67107

CPT code 67107 is a medical billing code for the surgical repair of a detached retina.

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What is CPT Code 67107

CPT code 67107 is a medical procedure code that describes the surgical repair of a detached retina using techniques that do not involve the use of vitrectomy. This procedure typically involves techniques such as scleral buckling or pneumatic retinopexy, where the retina is reattached to its proper position in the eye, helping to restore vision and prevent further vision loss.

Does CPT 67107 Need a Modifier?

For CPT code 67107, which is used for the repair of a detached retina, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of common modifiers that might be used with this procedure and the reasons for each:

1. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye underwent the procedure. Since retinal repairs are specific to each eye, indicating the correct side is crucial for accurate billing and medical records.

2. -50 (Bilateral procedure): If the procedure is performed on both eyes during the same surgical session, this modifier should be used. It often affects reimbursement, as some payers may adjust the payment for bilateral procedures.

3. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in payment adjustment policies where the secondary or additional procedures may be reimbursed at a lower rate.

4. -58 (Staged or related procedure or service by the same physician during the postoperative period): If a subsequent procedure is planned or anticipated as part of the treatment of the condition and occurs during the postoperative period of the first procedure, this modifier would be appropriate.

5. -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 a complication arises that necessitates a return to the operating room.

6. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a new procedure, which is not related to the original procedure, is performed while the patient is still in the postoperative period for the initial surgery, this modifier should be used.

7. -22 (Increased procedural services): When the work required to perform the surgery is substantially greater than typically required, this modifier can be applied to potentially increase reimbursement.

8. -23 (Unusual anesthesia): Occasionally, if unusual anesthesia is required for the retinal repair (outside of the typical local or regional anesthesia), this modifier might be used.

9. -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 crucial in situations where procedures might generally be bundled but were distinctly separate in a specific case.

Each of these modifiers serves to provide specific, necessary details that affect how the procedure is billed and reimbursed, ensuring that the healthcare provider's billing is accurate and compliant with payer requirements.

CPT Code 67107 Medicare Reimbursement

CPT code 67107, which pertains to the repair of a detached retina, is generally reimbursed by Medicare. This procedure is considered medically necessary when the criteria for retinal detachment repair are met, and therefore, it is covered under Medicare Part B, which includes outpatient medical services.

The reimbursement amount for CPT code 67107 can vary based on the geographic location of the service provider due to the Medicare Physician Fee Schedule (MPFS) adjustments. Additionally, the actual payment rate can be influenced by factors such as the facility type, whether the service is performed in a hospital outpatient setting or in an ambulatory surgical center, and the provider's acceptance of Medicare assignment.

For precise reimbursement rates, it is advisable to consult the latest MPFS lookup tool available on the CMS (Centers for Medicare & Medicaid Services) website or contact a local Medicare administrator. This will provide the most accurate and up-to-date information regarding the reimbursement specifics for CPT code 67107 in your specific region.

Are You Being Underpaid for 67107 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 67107 for retinal detachment repair, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring every procedure, including intricate surgeries like CPT code 67107, is reimbursed accurately and efficiently.

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