CPT Code 92358

CPT code 92358 is for temporary prosthesis services for patients with aphakia, a condition where the eye's lens is absent.

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What is CPT Code 92358

CPT code 92358 is designated for the professional services related to the temporary fitting of a prosthesis for aphakia. Aphakia is the absence of the lens of the eye, which can occur naturally or be caused by surgical removal. This code covers the expertise and time spent by healthcare professionals in fitting and adjusting a temporary prosthetic lens, which is essential for patients who have undergone lens removal and are awaiting a permanent solution.

Does CPT 92358 Need a Modifier?

For the CPT code 92358, which pertains to a temporary prosthesis service for aphakia (absence of the lens of the eye), several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side): Indicates that the service or procedure was performed on the left side of the body. This modifier is necessary when the service is specific to one side of the body to ensure accurate billing and documentation.

2. -RT (Right side): Indicates that the service or procedure was performed on the right side of the body. Like the -LT modifier, it is used for specificity in cases where the service is unilateral.

3. -E1 (Upper left, eyelid): Specifies that the service was performed on the upper left eyelid. This level of detail might be necessary for procedures involving specific parts of the eye area.

4. -E2 (Lower left, eyelid): Specifies that the service was performed on the lower left eyelid.

5. -E3 (Upper right, eyelid): Specifies that the service was performed on the upper right eyelid.

6. -E4 (Lower right, eyelid): Specifies that the service was performed on the lower right eyelid.

7. -22 (Increased procedural services): Indicates that the work performed was substantially greater than typically required. This could be due to complications or special circumstances that make the service more complex than usual.

8. -52 (Reduced services): Indicates that a service or procedure was partially reduced or eliminated at the physician’s discretion. This could apply if a full prosthesis was not necessary or the service was simplified.

9. -GA (Waiver of liability statement issued): Used when a provider expects that Medicare will deny payment for a service as not reasonable and necessary, and the patient has been informed of this and agrees to pay out of pocket.

10. -GK (Reasonable and necessary item/service associated with a GA or GZ modifier): Used to indicate that the service is expected to be covered by Medicare and is deemed reasonable and necessary under Medicare guidelines.

Each of these modifiers provides specific information that helps in the accurate processing and reimbursement of claims for services related to the temporary prosthesis for aphakia. It is crucial for healthcare providers to use the appropriate modifiers to ensure compliance with billing regulations and to facilitate appropriate payment.

CPT Code 92358 Medicare Reimbursement

The CPT code 92358, which pertains to services related to aphakia (typically involving temporary prosthetic services), is not a standard or recognized CPT code under the current American Medical Association (AMA) guidelines. Therefore, it is not reimbursed by Medicare. For accurate billing and reimbursement, it is crucial to use valid and recognized CPT codes. Healthcare providers should verify the correct CPT codes for aphakia-related services, such as initial fitting of contact lenses or eyeglasses following cataract surgery, which are typically covered under different, specific CPT codes. Always ensure to check the latest updates from Medicare and the AMA for the most accurate and current coding information.

Are You Being Underpaid for 92358 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision. RevFind specializes in detecting discrepancies down to specific CPT codes, such as 92358 for aphakia prosthesis services. This level of detail allows you to ensure that every 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 each service rendered.

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