CPT Code 67801

CPT code 67801 is for the surgical removal of eyelid lesions.

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What is CPT Code 67801

CPT code 67801 is designated for the procedure of removing eyelid lesions. This code is used when a healthcare provider performs the excision of chalazion, multiple, same lid. This procedure involves the surgical removal of small lumps or cysts that can form on the eyelid due to a blocked oil gland.

Does CPT 67801 Need a Modifier?

For CPT code 67801, which is used for the excision of chalazion or other eyelid lesions, 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. -RT (Right side) and -LT (Left side): These modifiers are used to indicate which eyelid was involved in the procedure. Since eyelid procedures are specific to each eye, specifying the side can be crucial for accurate billing and medical records.

2. -E1 (Upper left, eyelid), -E2 (Lower left, eyelid), -E3 (Upper right, eyelid), -E4 (Lower right, eyelid): These anatomical modifiers provide a more precise location of the eyelid lesion removal. They are particularly useful in documenting exactly where the lesion was located, which can be important for both clinical and billing purposes.

3. -50 (Bilateral procedure): If the procedure is performed on the same eyelid lesion but on both eyes during the same session, this modifier should be used. It indicates that the procedure was carried out in a bilateral fashion, which can affect reimbursement.

4. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It may be applicable if additional procedures, other than the eyelid lesion removal, are performed.

5. -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. It is crucial for preventing the bundling of procedures and ensuring appropriate reimbursement.

6. -76 (Repeat procedure by same physician): If the same physician repeats the eyelid lesion removal during the same session, this modifier would be appropriate. It helps in documenting that the procedure was repeated and is not a billing error.

7. -79 (Unrelated procedure or service by the same physician during the postoperative period): If the eyelid lesion removal is performed during the postoperative period of another unrelated procedure, this modifier would be necessary to indicate that the procedures are not connected.

Each of these modifiers serves to provide additional details that can affect how the procedure is billed and reimbursed. Accurate use of these modifiers ensures compliance with billing regulations and helps in the appropriate management of patient records.

CPT Code 67801 Medicare Reimbursement

CPT code 67801, which pertains to the excision of chalazion, multiple, same lid, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on the Medicare Administrative Contractor (MAC) in the specific geographic region where the service is provided. It is important for healthcare providers to check with their local MAC for the most accurate and current reimbursement rates. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement.

Are You Being Underpaid for 67801 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 67801 for the removal of eyelid lesions, RevFind ensures that each service rendered is reimbursed correctly according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure, including individual payer details.

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