CPT Code 67110

CPT code 67110 is a medical billing code for the surgical repair of a detached retina.

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What is CPT Code 67110

CPT code 67110 is designated for the surgical procedure that involves repairing a detached retina. This code is used specifically when the repair is done via a technique known as scleral buckling or vitrectomy, which are common methods to address this serious condition in the eye.

Does CPT 67110 Need a Modifier?

For CPT code 67110, 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 potential modifiers and the reasons for their use:

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's important to check payer policies as some may have specific rules regarding reimbursement for bilateral procedures.

3. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in the adjustment of reimbursement rates for the additional procedures, which are typically paid at a reduced 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 the patient needs to return to the operating room for a related procedure that was not planned at the time of the initial surgery.

6. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a new procedure, which is unrelated to the initial procedure, is performed while the patient is still in the postoperative period, this modifier should be used.

7. -24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period): In cases where an evaluation and management service is provided during the postoperative period for a reason unrelated to the original procedure, this modifier would be necessary.

8. -22 (Increased procedural services): When the work required to perform the surgery is substantially greater than typically required, this modifier can 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. It is essential for healthcare providers to use the correct modifiers to ensure compliance with billing regulations and to facilitate appropriate payment for services rendered.

CPT Code 67110 Medicare Reimbursement

CPT code 67110, which pertains to the repair of a detached retina, is generally reimbursed by Medicare. The reimbursement for this procedure, however, can vary based on several factors including the geographic location where the service is provided, the setting (inpatient or outpatient), and any additional services that might be required during the procedure.

To determine the specific reimbursement amount for CPT code 67110, 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. These resources can provide the most current and detailed reimbursement information, including any adjustments or updates that may affect payment.

Are You Being Underpaid for 67110 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. Specifically designed to scrutinize your contracts and identify discrepancies down to the CPT code level, RevFind ensures that services like 67110 - Repair detached retina, are fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can secure the payments you are entitled to for each specific procedure and payer.

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