# Procedures done by 2 different doctors



## vmounce (Mar 1, 2010)

I really need help on this one.  ASAP
I appreciate any information.

first doctor does complex microscopic phacoemulsification of cataract, blue dye was used.  Only 75% of cataract was removed.  There was virtually no capsular support remaining for the residual lens material.  Doctor had considered using capsular tension ring but due to strong possiblity of entire lens dislocating and the need for further lens removal.  No intraocular lens was place in the eye.  He consulted with 2nd doctor and below is what 2nd doctor did.     

From there, second doctor did his procedure that consist of:

Pars plana lensectiomy, os
pars plana vitrectomy, os
gas fluid exchange, os
endolaster, os

This is how the operative report reads:

PREOPERATIVE DIAGNOSIS:   Dislocated crystalline lens, OS.

POSTOPERATIVE DIAGNOSES:  
1.Dislocated crystalline lens, OS.
2.Rhegmatogenous retinal detachment, OS.

PROCEDURE:   
1.Pars plana lensectomy, OS.
2.Pars plana vitrectomy, OS.
3.Gas fluid exchange, OS.
4.Endolaser, OS.

INDICATIONS:  Patient who suffered trauma to the left eye several years ago and then subsequently developed a dense white cataract in this eye.  Doctor performed cataract surgery and intraoperatively it was found that he had very loose zonules and fibrotic anterior capsule.  A capsulorrhexis was performed and some of the lenticular material was lost into the posterior segment.  I was asked to perform a pars plana lensectomy at this point.  

OPERATIVE PROCEDURE:   First doctor had performed phacoemulsification of approximately half of the lenticular material.  

Two paracentesis sites were intact and sutured closed as well as an operative site that also was stitched closed.  An incision in the inferonasal conjunctival fornix was performed using blunt Westcott scissors and a blunt cannula was used to inject a 50:50 mix of 1% lidocaine without epinephrine and 0.75% Marcaine.  There was no complication with this injection.   

A transconjunctival scleral trocar was placed inferotemporal 3.5 mm posterior to the limbus.  The infusion line was placed into this port and it was viewed from the pupil and then turned on.  Additional ports were placed superotemporal and superonasal.  The BIOM visualization system was used throughout the case as well as an endoilluminator.  Some of the anterior cortical material was removed using a vitreous cutter and endoilluminator.  Subsequently, it was determined that the fragmatome was needed to remove the nucleus so the superotemporal port was removed and this wound was enlarge dafter a peritomy was performed of the conjunctiva to approximately a 20-gauge size.  Subsequently, the anterior lenticular material was removed using the fragmatome as well as the endoilluminator.  After this was removed, it was found that the retina was detached for 360 degrees.  This appeared to be chronic in nature as there was pigmentary cells on the retinal surface and there were sclerotic blood vessels on the retinal surface as well.  The retina appeared to be thin and atrophic superiorly as well.  The vitreous was then removed using the vitreous cutter.  The remaining lenticular material was removed meticulously by raising it in the vitreous cavity and removing it using the fragmatome.  The retinal periphery was then examined in detail and a retinal tear was found superotemporal at the vitreous base.  Subsequently, a drainage retinotomy was fashioned nasally at the level of the optic disc using the endodiathermy.  A cannula was used to drain the subretinal fluid out from underneath the retinal.  The retina flattened entirely under gas.  Again, there appeared to be some sclerotic blood vessels along the superotemporal arcade.  Some small cortical material was found over the macular surface.  Endolaser was then applied surrounding the retinotomy site for 360 degrees, and 5-6 rows of endolaser was applied at the vitreous base for 360 degrees.  Also, laser was performed in a PRP fashion in the ischemic area along the superotemporal arcade.  The retina remained entirely attached underneath the gas.


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## ASC CODER (Mar 1, 2010)

67108 
66982 74


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## ASC CODER (Mar 1, 2010)

first doc could be 66982 74
second doc could be 67108

the first procedure was discontinued because of concerns for the patients health. 

Second procedure done by different doc this is well documented so I don't see why you could not get paid for both.


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## vmounce (Mar 1, 2010)

Could I use modifier 52 with 66982 instead of 74?


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## ASC CODER (Mar 1, 2010)

52

Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. Note: For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use). [revised 1/1/2009] 

74

Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia: Due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.





I would use 74. The doc had extra work hense the 66982 complexity of the procedure.


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## vmounce (Mar 1, 2010)

I appreciate the information. 

Vickie


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## vmounce (Mar 1, 2010)

Also,  I just checked with the first doctor that you said to use 66982 with 74 The doctors office is using 66850 with modifier 24.  I thought our codes were suppose to match.  The doc will not change his.  I do feel the code you said to use is more accurate.

Vickie


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## ASC CODER (Mar 1, 2010)

using dye and all the extra work that the doc performed is not reflected in this code 66850


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## vmounce (Mar 1, 2010)

Thank you and have a good day.

Vickie


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## ASC CODER (Mar 1, 2010)

your welcome and you too.

I hope I was some help


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## vpcats (Mar 5, 2010)

If there was no IOL placed in the eye by the 1st doctor, how do you code 66982?


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## delphinus777 (Mar 10, 2010)

vpcats ----  by adding the modifier to that code it justifies the service billed


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