CPT Code 67930

CPT code 67930 is for the surgical repair of an eyelid wound.

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What is CPT Code 67930

CPT code 67930 is designated for the surgical repair of an eyelid wound that involves suturing. This procedure typically addresses more complex injuries that may involve multiple layers of the eyelid tissue.

Does CPT 67930 Need a Modifier?

For the CPT code 67930, which pertains to the repair of an eyelid wound, 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 repaired, whether the right or the left. This is crucial for accurate billing and medical records, as procedures may differ in complexity and recovery based on the side affected.

2. -E1 (Upper left, eyelid) and -E2 (Lower left, eyelid), -E3 (Upper right, eyelid), -E4 (Lower right, eyelid): These more specific eyelid modifiers help in providing exact details about the eyelid that was involved in the procedure. They are particularly useful in cases where multiple procedures might be performed on different eyelids during the same session.

3. -51 (Multiple procedures): This modifier is used if multiple procedures were performed during the same surgical session. It is important for ensuring appropriate payment adjustments are made for additional procedures.

4. -59 (Distinct procedural service): This modifier indicates that the procedure was distinct or independent from other services performed on the same day. It is used to signify that the procedure was separate and necessary at the time of surgery.

5. -76 (Repeat procedure by same physician): This modifier would be used if the same physician had to repeat the eyelid repair during the same session due to unforeseen circumstances or complications.

6. -79 (Unrelated procedure or service by the same physician during the postoperative period): If the eyelid repair was performed during the postoperative period of another unrelated procedure and by the same physician, this modifier would be necessary.

7. -22 (Increased procedural services): When the work required to repair the eyelid wound is substantially greater than typically required, this modifier can be used to indicate that the procedure was more complex or time-consuming than usual.

Each of these modifiers serves to provide clear, specific information that affects how the procedure is billed and reimbursed, ensuring that all aspects of the care provided are accurately documented and compensated.

CPT Code 67930 Medicare Reimbursement

CPT code 67930, which pertains to the repair of an eyelid wound, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service, the setting in which the procedure is performed (e.g., hospital outpatient department, physician's office), and the Medicare Administrative Contractor (MAC) policies for that region.

To determine the exact reimbursement amount for CPT code 67930, 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 services based on the locality. Additionally, providers should verify coverage and any specific documentation requirements with their local MAC to ensure compliance and proper claim submission.

Are You Being Underpaid for 67930 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 67930 for eyelid wound repair, RevFind ensures that each claim is fully compensated according to the terms agreed with individual payers. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring that every procedure, including intricate eyelid repairs, is paid correctly and promptly.

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