CPT Code 67112

CPT code 67112 is a medical billing code for the rerepair of a detached retina.

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What is CPT Code 67112

CPT code 67112 is used to denote a medical procedure involving the rerepair of a detached retina. This code is specifically utilized when a previous surgical attempt to repair the detached retina has been unsuccessful or has partially failed, necessitating a subsequent surgical intervention to correct the detachment. The procedure typically involves techniques to reattach the retina to its proper position in the eye, aiming to restore or preserve vision.

Does CPT 67112 Need a Modifier?

For CPT code 67112, which is used for the rerepair 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, as retinal detachments are specific to each eye.

2. -50 (Bilateral procedure): If the rerepair procedures were performed on both eyes during the same operative session, this modifier would be appropriate.

3. -78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period): This modifier could be used if the patient requires a return to the operating room for a related procedure that was not anticipated in the initial plan.

4. -79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period): If a new issue arises in the postoperative period that requires an unrelated procedure, this modifier would be necessary.

5. -58 (Staged or related procedure or service by the same physician during the postoperative period): This modifier is used if the rerepair of the retina is a planned, staged, or more extensive procedure following the initial surgery.

6. -22 (Increased procedural services): If the procedure requires significantly more effort than typically required, this modifier can be used to indicate that the service provided was more complex than usual.

7. -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.

8. -51 (Multiple procedures): Used if multiple procedures are performed during the same surgical session, other than the rerepair of the retina.

Each of these modifiers serves to provide specific information that can affect billing and reimbursement processes, ensuring that the services rendered are accurately documented and appropriately compensated.

CPT Code 67112 Medicare Reimbursement

CPT code 67112, which refers to the rerepair of a detached retina, is generally reimbursable by Medicare. The reimbursement for this procedure, however, can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (hospital outpatient department vs. an ambulatory surgical center), and the specifics of the patient's Medicare plan.

To determine the exact reimbursement amount for CPT code 67112, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes across different localities.

Additionally, providers should ensure that the documentation supports the medical necessity of the procedure as Medicare only covers services that are considered reasonable and necessary. In the case of a rerepair of a detached retina, detailed surgical notes and a clear indication of the failure of the initial repair would be crucial for coverage and reimbursement.

Are You Being Underpaid for 67112 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 67112 for rerepair of a detached retina, RevFind ensures that each claim is fully compensated according to the agreed terms with individual payers. Schedule a demo today to see how RevFind can safeguard your earnings and streamline your billing processes.

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