CPT Code 67830

CPT code 67830 is used for billing the surgical revision of eyelashes, typically due to conditions like trichiasis.

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What is CPT Code 67830

CPT code 67830 is designated for the procedure involving the revision of eyelashes. This typically includes interventions to correct issues such as entropion or trichiasis, where eyelashes grow abnormally and irritate the eye. The procedure may involve excision, repair, or other forms of surgical correction to alleviate the condition and prevent further damage to the eye.

Does CPT 67830 Need a Modifier?

For CPT code 67830, which pertains to the revision of eyelashes, 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 excessive scar tissue, severe entropion, or other complicating factors.

2. -50 (Bilateral Procedure): If the revision of eyelashes is performed on both eyes during the same surgical session, this modifier should be used to indicate a bilateral procedure.

3. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement for multiple procedures that are not normally performed together.

4. -52 (Reduced Services): This modifier is applicable if the procedure is partially reduced or eliminated at the physician's discretion. For instance, if only a minor adjustment is needed that does not require the full extent of the typical procedure.

5. -53 (Discontinued Procedure): Applied when a procedure is terminated after the initiation due to extenuating circumstances or those that threaten the well-being of the patient during surgery.

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

7. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.

8. -56 (Preoperative Management Only): Indicates that a physician only provided preoperative care when the surgery was performed by another doctor.

9. -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 be relevant if other, non-related procedures were performed on the eyelids or nearby structures during the same session.

10. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eyelid was operated on if only one eye was involved in the procedure.

Each of these modifiers addresses specific circumstances that might affect how the procedure is billed and reimbursed, ensuring accurate and fair compensation for the services provided.

CPT Code 67830 Medicare Reimbursement

CPT code 67830, which pertains to the revision of eyelashes (e.g., epilation by forceps), is generally considered a medically necessary procedure under specific circumstances, such as when patients suffer from trichiasis, a condition where eyelashes grow abnormally towards the eye, causing irritation or damage to the eye itself.

Medicare reimbursement for CPT code 67830 is typically available when the procedure is deemed medically necessary. The amount reimbursed can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., outpatient hospital, physician's office), and other factors. It is essential for healthcare providers to verify coverage specifics and reimbursement rates directly with their local MAC or through the Medicare Physician Fee Schedule (MPFS) lookup tool available on the CMS (Centers for Medicare & Medicaid Services) website.

Providers should ensure proper documentation of medical necessity and adherence to relevant Medicare guidelines to facilitate appropriate reimbursement for this procedure.

Are You Being Underpaid for 67830 CPT Code?

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