CPT Code 67902

CPT code 67902 is used for billing the surgical repair of an eyelid defect.

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What is CPT Code 67902

CPT code 67902 is designated for procedures involving the repair of an eyelid defect that requires more complex surgical techniques, such as the use of grafts or flaps. This code is used when the repair goes beyond simple sutured closure, addressing functional and aesthetic restoration of the eyelid.

Does CPT 67902 Need a Modifier?

For the CPT code 67902, which pertains to the repair of an eyelid defect, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. 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 medical records and billing.

2. -50 (Bilateral procedure): If the procedure was performed on both eyelids during the same operative session, this modifier should be used to indicate a bilateral procedure.

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 lower rate.

4. -22 (Increased procedural services): If the procedure required a greater effort than typically required, this modifier could be added to indicate that the procedure was more complex or time-consuming than usual.

5. -52 (Reduced services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier would be appropriate to indicate that the service provided was less than usually required.

6. -79 (Unrelated procedure or service by the same physician during the postoperative period): This modifier is used if a new procedure is performed by the same physician during the postoperative period of the initial procedure, which is unrelated to the initial procedure.

7. -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, performed during the postoperative period of the initial procedure.

Each of these modifiers provides specific information that can affect billing and reimbursement processes, ensuring that the healthcare provider's billing is accurate and compliant with insurance requirements.

CPT Code 67902 Medicare Reimbursement

CPT code 67902, which pertains to the repair of an eyelid defect, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (e.g., outpatient hospital, ambulatory surgical center, or office), and the Medicare Administrative Contractor (MAC) policies that apply to the region.

To determine the exact reimbursement amount for CPT code 67902, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information about the reimbursement rates for specific procedures based on the provider's locality.

Additionally, it is important for providers to ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement from Medicare. Proper coding and documentation are essential to avoid denials or delays in payment.

Are You Being Underpaid for 67902 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 67902 for eyelid defect repairs, RevFind ensures that each claim is fully compensated 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 billed.

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