CPT Code 67875

CPT code 67875 is a medical procedure for temporarily closing an eyelid using sutures.

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What is CPT Code 67875

CPT code 67875 is used to describe a medical procedure involving the temporary closure of an eyelid using sutures. This code is typically employed when the procedure is necessary to protect the eye due to various conditions or injuries that prevent the eyelid from functioning normally. The suturing helps in maintaining the eyelid closed to facilitate proper healing or protection of the ocular surface.

Does CPT 67875 Need a Modifier?

For the CPT code 67875 (Closure of eyelid by suture, involving lid margin), 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) or -LT (Left side): These modifiers are used to specify which eyelid was operated on, whether the right or the left. This is crucial for accurate billing and medical records, as procedures might differ between sides.

2. -50 (Bilateral procedure): If the procedure is performed on both eyelids during the same operative session, this modifier should be used. It indicates that both the right and left sides were addressed.

3. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in the adjustment of reimbursement rates for the additional procedures.

4. -52 (Reduced services): If the procedure performed was reduced in comparison to the usual range of services (e.g., only partial closure), this modifier would be appropriate.

5. -53 (Discontinued procedure): Applied when a procedure is terminated after it has begun but before it is completed, due to reasons not related to the patient's condition.

6. -54 (Surgical care only): Used when one physician performs the surgery and another provides preoperative and/or postoperative management.

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

8. -56 (Preoperative management only): Indicates that the physician was only involved in the preoperative planning and evaluation, not the actual surgery or postoperative care.

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.

10. -79 (Unrelated procedure or service by the same physician during the postoperative period): This modifier is used if another procedure is performed that is not related to the initial procedure during the postoperative period.

11. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): For when an evaluation and management service is performed during the postoperative period that is not related to the original procedure.

Each of these modifiers provides specific information that affects how billing and reimbursement are handled, ensuring that the services rendered are accurately documented and compensated.

CPT Code 67875 Medicare Reimbursement

The CPT code 67875, which pertains to the closure of the eyelid by suture, typically falls under procedures that are reimbursable by Medicare. However, the specific coverage and reimbursement rates can depend on several factors including the medical necessity of the procedure, the setting in which the procedure is performed (e.g., outpatient, inpatient), and the geographic location of the service provider.

To determine the exact reimbursement amount for CPT code 67875, you would need to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. The MPFS provides detailed information on the reimbursement rates for each CPT code, which are adjusted based on the locality-specific factors.

It's also important to ensure that proper documentation and justification for the medical necessity of the procedure are provided when submitting claims to Medicare to facilitate smooth processing and reimbursement. Always verify with the latest CMS updates or contact Medicare directly for the most accurate and current reimbursement information.

Are You Being Underpaid for 67875 CPT Code?

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