CPT Code 68399

CPT code 68399 is used for billing unlisted procedures related to the conjunctiva.

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What is CPT Code 68399

CPT code 68399 is designated for an unlisted procedure related to the conjunctiva. This code is used when a specific procedure performed on the conjunctiva does not have a corresponding CPT code already assigned. It allows healthcare providers to bill for conjunctival procedures that are not otherwise classified in the CPT coding system.

Does CPT 68399 Need a Modifier?

Certainly! For the CPT code 68399, which is an unlisted procedure code for the conjunctiva, modifiers may be necessary to provide additional information to the payer about the circumstances under which the service was provided. Here are some commonly used modifiers that could be applicable, depending on the specific situation:

1. -22 (Increased Procedural Services): This modifier is used when the work required to perform a procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work.

2. -52 (Reduced Services): Use this modifier when a service or procedure is partially reduced or eliminated at the physician's discretion. This informs the payer that a service was performed but to a lesser extent than described by the CPT code.

3. -53 (Discontinued Procedure): Applied when a procedure is terminated due to unforeseen circumstances which may threaten the well-being of the patient.

4. -73 (Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia): This modifier is used to indicate that a procedure was canceled due to reasons related to the patient's condition prior to the administration of anesthesia.

5. -74 (Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia): Similar to -73, but used when the procedure is discontinued after anesthesia is administered.

6. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.

7. -76 (Repeat Procedure by Same Physician): This modifier is used to indicate that a procedure was repeated by the same physician on the same day.

8. -77 (Repeat Procedure by Another Physician): Used when a procedure is repeated by a different physician on the same day.

9. -TC (Technical Component): Indicates that only the technical component of the procedure was performed.

10. -26 (Professional Component): Indicates that only the professional component of the procedure was performed.

11. -GA (Waiver of Liability Statement on File): Used to indicate that the provider expects that the service may be denied as not reasonable and necessary and has on file a signed waiver from the patient agreeing to pay if the service is denied.

12. -GX (Notice of Liability Issued, Voluntary Under Payer Policy): Used to indicate that a notice of liability was issued when the service may or may not be covered by the payer.

Each of these modifiers provides specific information that can affect reimbursement and is essential for accurate billing and minimizing claim denials. It's important to choose the correct modifier based on the specific circumstances of the procedure performed.

CPT Code 68399 Medicare Reimbursement

The CPT code 68399, described as "Unlisted procedure, conjunctiva," is a code used for procedures on the conjunctiva that do not have a specific CPT code assigned. Regarding Medicare reimbursement, unlisted procedure codes like 68399 typically require additional documentation to justify the necessity and the specifics of the procedure performed. This is because unlisted codes do not have a predetermined Medicare fee schedule amount, and reimbursement can vary.

For Medicare to consider reimbursement for an unlisted code, the provider must submit a claim with detailed documentation, including a report describing the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service. Additionally, it is common practice to reference a similar procedure (with an established CPT code) as a benchmark for determining the appropriate reimbursement level.

Since there is no set reimbursement amount for CPT code 68399, the actual reimbursement will depend on the review of the submitted documentation and the Medicare contractor’s determination of the procedure's value relative to comparable procedures. Providers should prepare for potential additional correspondence with Medicare to justify the use of this unlisted code and to facilitate appropriate reimbursement.

Are You Being Underpaid for 68399 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and identifying discrepancies down to the CPT code level, including specific codes like 68399 for unlisted procedures on the conjunctiva. By analyzing payments from individual payers, RevFind ensures that your healthcare organization receives every dollar it is owed. Schedule a demo today to see how RevFind can streamline your payment processes and safeguard your revenue.

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