65435 CPT code reimbursement

65435 CPT Code Reimbursement (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

65435 CPT code reimbursement bills for service when the physician performs removal of corneal epithelium with or without the utilization of chemo-cauterization (abrasion, curettage). Physicians perform surgery to remove the outer-most layer of the cornea (the clear tissue that covers the eyeball) by scraping or cutting it with a spatula or curette (e.g. 65435). 

65435 CPT Code Reimbursement Summary

Corneal epithelial defects typically arise from infections, corneal dryness, mechanical trauma, and post-surgical changes. Moreover, The reasons are Ultraviolet burns, Limbal stem cell deficiency, and Neurotrophic keratopathy.

Chemical cauterization may apply for the removal of the cornea. CPT 65436 uses when the physician’s alternative of scrapping and cutting usually requires a swab of EDTA (ethylenediaminetetraacetic acid). This acid destroys the corneal epithelium.

After that, an antibiotic ointment or pressure patch applies to the surgical site once the procedure is complete. A subconjunctival injection or a topical anesthetic may use instead of general anesthesia when the process performs.

65435 CPT Code Reimbursement Description 

65435 CPT code reimbursement bills for service when the physician performs removal of corneal epithelium with or without the utilization of chemo-cauterization (abrasion, curettage). 

65435 cpt code

65435 CPT Code Reimbursement

A maximum of 1 unit of 65435 CPT code reimbursement can bill on the same service date. At the same time, two can pay when documentation supports the medical necessity of CPT 65435.

When performed in the facility, the cost, and RUVS of CPT 65435 will be $76.12 and 2.19972, respectively. In comparison, non-facility will be $92.39and 2.66972, respectively.

Surgical trays (A4550) does not cover by Medicare, and It’s not appropriate to bill separately. Check the third-party or commercial payers guideline if they cover this service.

65435

65435 CPT Code Reimbursement Modifiers 

The following is a list of modifiers that are applicable with 65435 CPT code reimbursement:

  • 22, 23,47, 50, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, Ai, AQ, AR, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, GY, GZS, KX, LT, PT, Q5, Q6, QJ, RT, SG, XE, XP, XS, XU.

If physicians believe that Medicare will deny such service, reporting with an AT modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and 65435 CPT code reimbursement must apply the GA modifier to that service. 

Modifier 22 applies to CPT 65435 when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT code 65435 when general or local anesthesia administers by the physician and routinely does not require during the procedure. 

Modifier 76 will be attached to 65435 CPT code reimbursement if service repeats by the Same Physician on the same day. In contrast, modifier 77 is appropriate when a procedure repeats on the same date service by a different physician. 

Modifier 78 will be appended with CPT code 65435 if the procedure repeats for an identical condition in the global period. For instance, the patient had surgery for cornea tissue removal and saw by a chiropractor for surgery-related issues. 

In contrast, modifier 79 is applicable when the service reports for an unrelated condition, e.g., a Patient seen by the physician in the post-operative period for a headache instead of Cornea surgery-related issues.  

Modifier 59 is applicable with 65435 CPT code reimbursement if any other procedure performs in combination with these services. They do not typically play together on the same date of service. Moreover, modifier 59 will be appropriate, or service performs on the distinct region on the same day. 

Modifier 53 will be reported with CPT code 65435 if unsuccessful removal of cornea tissue due to unavoidable circumstances like allergic reactions to the substance.

Modifier 52 applies when the physician does not complete the removal of cornea tissue and service terminates due to unavoidable circumstances.

65435 CPT Code Reimbursement Billing Guidelines

Documentation should support the medical necessity of service. It reflects that counseling service is medically necessary and appropriate. 

The reimbursable ICD 10 codes are B49, H16.001, H16.002, H16.003, H16.009, H16.011, H16.012, H16.012, H16.013, H16.019, H16.021, H16.022, H16.022, H16.023, H16.029, H16.041, H16.042, H16.043, H16.049, H16.061, H16.062, H16.063, H16.069, H16.121, H16.122, H16.123, and H16.129.

H18.40, H18.421, H18.422, H18.423, H18.429, H18.43, H18.441, H18.442, H18.443, H18.449, H18.451, H18.452, H18.459, H18.461, H18.462, H18.463, H18.469, H18.49, H18.601, H18.602, H18.603, H18.609, H18.611, H18.612, H18.613, H18.619, H18.831, H18.832, H18.833, and H18.839.

S05.00XA, S05.01XA, S05.02XA, T26.10XA, T26.11XA, T26.12XA, T26.60XA, T26.61XA, and T26.62XA.

65435 CPT code reimbursement includes an Operating microscope (69990) and does not report separately. 

CPT 64535 performs in combination with Collagen cross-linking. The cornea (0402T) reports CPT 0402T separately with the appropriate modifier. 

CPT 65436 reports instead 65436 when removal cornea tissue performs other than cutting and scrapping. 

65435 CPT Code Reimbursement Examples

The following are examples when 65435 CPT code reimbursement bills:

Example 1

A 60-year-old male with no past medical history now presents to the hospital outpatient setting for blurry vision and ocular pain. The patient lays down in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache.

 He reports that the pain was very severe. His headaches are usually associated with HTN. The blood pressure shows a value of 210/100. It denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting. 

The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.

Example 2

A 70 y/o male with no past medical history presents to the hospital outpatient setting because of bilateral ocular pain. The patient was with poor visibility and had a cloudy vision. The patient had been using eye drops for the previous two weeks. 

The patient denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting. A physical exam reveals erosion in bilateral eyes. 

The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.

Example 3

An 80-year-old female presents to the office for traumatic injury of the right eye. she has poor visibility, pain in the right eye, and headache. She did not take any medication for the pain. He restricts to home due to poor eyesight.

The patient denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting. A physical exam reveals erosion in bilateral eyes. 

The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.

Example 4

A 56-year-old male presents to the ophthalmologist with blurry vision. He complains that he is unable to see anything. The patient said that visibility is getting poorer day by day.

The patient was unable to move freely at home due to poor visibility. 

The physician examined both his eyes and saw cloudiness. The patient also has frequent headaches and denies any other symptoms, such as numbness, digestive and urinary bladder issues, extremity swelling, or dizziness. 

The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.

Example 5

A 70-year-old male presents to the office with a past medical history of chronic kidney disease and diabetic retinopathy. The patient has had ocular pain for one week. The patient was using any medication for the pain. 

The patient denies any other symptoms like body aches, shortness of breath, numbness, abdominal pain, and urinary bladder symptoms. The patient also has elevated Diabetes and a higher risk of vision loss. The physician consulted with an ophthalmologist about his condition. 

The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.

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