CPT Code 67935

CPT code 67935 is used for billing the surgical repair of an eyelid wound.

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What is CPT Code 67935

CPT code 67935 is designated for the surgical repair of an eyelid wound. This code is used when a healthcare provider performs a procedure to close and repair a laceration or injury to the eyelid, which may involve suturing and other methods to ensure proper healing and function of the eyelid.

Does CPT 67935 Need a Modifier?

For the CPT code 67935, which pertains to the repair of an eyelid wound, several modifiers may be applicable depending on the specific circumstances of the surgical procedure. Here’s 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 indicate which eyelid was operated on, whether the right or the left. This is crucial for accurate billing and medical records, as procedures might differ in complexity and recovery based on the side affected.

2. -E1 (Upper left, eyelid), -E2 (Lower left, eyelid), -E3 (Upper right, eyelid), -E4 (Lower right, eyelid): These more specific eyelid modifiers provide detailed information about the exact location of the procedure on the eyelid. They help in clarifying the surgical area for precise documentation and billing.

3. -51 (Multiple procedures): This modifier is used if multiple procedures were performed during the same surgical session. It helps in billing adjustments since insurers often reimburse secondary procedures at a reduced rate.

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 crucial for preventing bundling and ensuring separate payment.

5. -76 (Repeat procedure by same physician): Used if the same physician had to repeat the eyelid repair during the same session, perhaps due to unforeseen complications or incomplete initial repair.

6. -79 (Unrelated procedure by the same physician during the postoperative period): If the eyelid repair was performed during the postoperative period of another unrelated procedure and was not planned in the initial surgery session, this modifier would be appropriate.

7. -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 extensive trauma or pre-existing complications.

Each of these modifiers serves to provide clear, specific information that aids in the accurate coding and billing process, ensuring that the healthcare provider is reimbursed correctly and the patient’s medical records are precise.

CPT Code 67935 Medicare Reimbursement

CPT code 67935, 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 provider, the complexity of the procedure, and any applicable Medicare adjustments or policies.

To determine the exact reimbursement amount for CPT code 67935, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes based on the locality. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement from Medicare.

Are You Being Underpaid for 67935 CPT Code?

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