CPT Code 67414

CPT code 67414 is a medical procedure for exploring or decompressing the eye socket.

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What is CPT Code 67414

CPT code 67414 is a medical procedure code that describes the exploration or decompression of the eye socket. This procedure is typically performed to relieve pressure or to investigate and address abnormalities within the orbital space, which may involve the removal of bone or other tissue to alleviate compression on the eye and associated structures.

Does CPT 67414 Need a Modifier?

For CPT code 67414, which pertains to the exploration or decompression of the eye socket, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:

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 extensive scar tissue, severe trauma, or other complications that make the procedure more complex.

2. -50 (Bilateral Procedure): If the exploration or decompression is performed on both eye sockets during the same surgical session, this modifier should be used to indicate that the procedure was bilateral.

3. -51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in adjusting the reimbursement for the additional procedures, which are generally paid at a reduced rate.

4. -52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier would be applicable. It indicates that the procedure was curtailed without altering the overall nature of the service.

5. -53 (Discontinued Procedure): Used when a surgery is terminated after the patient has been prepared for it, but before the actual surgical procedure is performed, due to reasons like patient safety.

6. -54 (Surgical Care Only): When one physician performs the surgical care and another provides preoperative and/or postoperative management, this modifier is used.

7. -55 (Postoperative Management Only): This modifier is used when one physician performs the postoperative management and another physician has performed the surgical procedure.

8. -56 (Preoperative Management Only): Used when one physician performs the preoperative care and another performs the surgical procedure.

9. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used for procedures that are planned prospectively or more extensive than the original procedure.

10. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day.

11. -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 when a return to the operating room is required to address a complication from the initial procedure.

12. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a new procedure is performed by the same physician during the postoperative period of the initial procedure, which is not related to the initial procedure.

13. -80 (Assistant Surgeon): Used when an assistant surgeon is present to help the primary surgeon during the procedure.

14. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used specifically for non-physician practitioners who assist in surgery.

Each of these modifiers addresses specific circumstances surrounding the surgical procedure, ensuring accurate documentation and appropriate reimbursement for services rendered.

CPT Code 67414 Medicare Reimbursement

CPT code 67414, which pertains to the exploration or decompression of the eye socket, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the setting in which the procedure is performed (e.g., hospital outpatient department vs. an ambulatory surgical center).

To determine the exact reimbursement amount, 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 provide detailed information on the reimbursement rates applicable to different procedures under Medicare.

Are You Being Underpaid for 67414 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and identifying discrepancies down to the CPT code level, including specific codes like 67414 for eye socket exploration and decompression procedures. By analyzing payments from individual payers, RevFind ensures that your healthcare facility receives every dollar it is owed. Schedule a demo today to see how RevFind can streamline your payment processes and safeguard your revenue.

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