Modifier –57 indicates that this is the exam to determine the need for surgery. *The codes shown are only suggestions. Canthus Repair and Lid Repair and Floppy Eyelid Syndrome Repair (CPT codes 67950, 67961 and 67966) • Medicare does not have a National Coverage Determination (NCD) for canthus repair and lid repair or for floppy eyelid syndrome repair. The reason for the denial may vary because: The codes may be mutually exclusive. The following codes are atypical —in that the bilateral payment adjustment does not apply to them—because of 1) physiology or anatomy or 2) the code description specifically states that it is a unilater procedure and there is an existing code for the bilateral procedure. 6. CPT codes with a bilateral indicator of zero. Correct coding for the exam. Optum360 ® EncoderPro.com is an online coding and reference tool designed to enhance your coding capabilities. HCP services are generally billed using evaluation and management codes, which may be accompanied by prolonged service codes when appropriate. CPT: Visibility: Summary Only: Description: CPT is a list of descriptive terms and identifying numeric codes for medical services and procedures that are provided by physicians and health care professionals. Correct coding for the surgery. LCDs are decisions by a fiscal intermediary or carrier on whether a service is considered reasonable and necessary and whether it will be covered on an intermediary-wide or carrier-wide basis. • Local Coverage Determinations (LCDs)/Local Coverage Articles (LCAs) do not exist at this time. The following code edits apply to surgical services from the 10000 series of CPT billed with other services. Brow ptosis (CPT 67900) is considered reconstructive and medically necessary when the following criteria are present: ®Other causes have been eliminated as the primary cause for the Visual Field obstruction (e.g., Botox treatments within the past six (6) months); and Patient must have a functional complaint related to brow ptosis. codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. CPT® Code 67961 in section: Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement The list of Local Coverage Determinations organized by State. CMS-1500 and CMS-1450 coding guide For additional guidance on the appropriate use of prolonged service codes, please refer to the 2018 CPT® code book. CPT code 67036–79–LT (for the vitrectomy) and CPT code 66984–59–79–LT (for the cataract removal). If a surgeon performs cataract surgery (CPT code 66984) and trabeculectomy (CPT code 66170) in the same session, list the procedures as follows: 66170 66984 -51 Medicare will base payment on 100 percent of the largest procedure and 50 percent each for up to four secondary procedures. If the code in the left column is billed with any of the codes in the right column, one of the codes will deny. Use of modifier. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 Original Effective Date CPT codes not covered for indications listed in the CPB: Thermal therapy (e.g., radiofrequency (ThermiVa and Viveve procedures) and laser) - no specific code: 0419T: Destruction neurofibroma, extensive, (cutaneous, dermal extending into subcutaneous); face, head … The same goes for multiple procedures. The appropriate level of E&M (9921X–57) or Eye code (9201X–57). From ICD-10 mapping tools and supplemental modules to three different levels of encoder referential coding support, EncoderPro.com assists you in staying current, compliant and competitive. Other CPT codes related to the CPB: 11900 - 11901: Injection, intralesional: 92081 - 92083: Visual field examination [not routinely necessary for excess upper eyelid skin, upper eyelid ptosis, or brow ptosis] ICD-10 codes covered if selection criteria are met: H02.401 - H02.439: Ptosis of eyelid [causing functional visual impairment] Q10.0