CPT Code 67805

CPT code 67805 is for the surgical removal of eyelid lesions.

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What is CPT Code 67805

CPT code 67805 is designated for the excision of chalazion, cyst, or tumor from the eyelid, involving an incision and drainage. This procedure is typically performed when the lesion is larger or requires more complex surgical intervention.

Does CPT 67805 Need a Modifier?

For CPT code 67805, which is used for the excision of chalazion or other eyelid lesion without closure or with simple direct closure, 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 specify which eyelid was operated on, whether the right or left. This is 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 specific location of the eyelid lesion removal. They help in detailing the exact eyelid quadrant which aids in precise documentation and can affect reimbursement.

3. -50 (Bilateral procedure): If the procedure is performed on the same eyelid lesions but on both eyes during the same session, this modifier should be used. It indicates that the procedure was bilateral, which can impact how payment is processed.

4. -51 (Multiple procedures): This modifier is used when multiple procedures, other than E/M services, are performed at the same session by the same provider. It may be necessary if additional procedures beyond the eyelid lesion removal are performed.

5. -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 could apply if the eyelid lesion removal was performed in conjunction with another, separate procedure.

6. -76 (Repeat procedure by same physician): If the same procedure needs to be repeated on the same day due to specific clinical reasons, this modifier would be appropriate.

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, and it is necessary to indicate that the procedures are not related, this modifier would be used.

Each of these modifiers serves to provide additional details that ensure proper billing and compliance with insurance requirements. It's important for healthcare providers to use these modifiers correctly to avoid delays in payment or denials of claims.

CPT Code 67805 Medicare Reimbursement

CPT code 67805, which pertains to the excision of chalazion, multiple, same lid, is generally reimbursable by Medicare. However, the specific reimbursement amount for this procedure can vary based on the geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, physician's office). To determine the exact reimbursement rate, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your Medicare Administrative Contractor (MAC). This will provide the most accurate and up-to-date information regarding reimbursement for CPT code 67805.

Are You Being Underpaid for 67805 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 pinpointing discrepancies down to the CPT code level, including specific codes like 67805 for the removal of eyelid lesions. This precision allows you to ensure that each claim is reimbursed correctly according to the terms of your agreements with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.

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