Ophthalmology and Optometry Coding Alert

Don't split at the seams standing behind your coding method for recurrent retinal detachment repairs there's more than one way that you can code this procedure and get paid. Two retinal repair codes top coders'charts as the most difficult to use: 67108 (Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique) and 67112 ( by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair[s] using scleral buckling or vitrectomy techniques).

The confusion surrounding CPT codes 67108 and 67112 is attributable to the similarity in the language used in their descriptors and the failure of CPT to instruct coders on which code should be used for recurrent repairs. As a general rule, coders think of CPT code 67108 as representing an initial retinal detachment repair procedure and 67112 as representing subsequent retinal detachment repairs. But this rule of thumb does not always apply, and that's a good thing here's why. CPT codes 67108 and 67112 just don't measure up when it comes to reimbursement. The RVUs for initial retinal detachment repair (67108) are significantly higher than the RVUs allotted to 67112, 39.33 and 33.21 respectively. In average dollar amounts, this translates into a payment of $1,360.50 for 67108 and just $1,148.80 for 67112 a difference of $211.70. Take Our Advice for 67108 Lori H. Winnie, CPC, coding specialist with Southeastern Retina Associates in Chattanooga, Tenn., gives coders the following scenarios to illustrate how to use codes 67108 and 67112. Do use code 67108 with a modifier to code a repair of a recurrent retinal detachment when the definition of the code is met. If the surgeon performs the elements that are described in 67108, he or she should use that code to bill the service regardless of whether the surgery is subsequent to an initial 67108. For example, if a patient undergoes procedure 67108 in his right eye and three weeks later he returns with retinal detachment in his left eye, both procedures can hypothetically be coded with 67108 (for the first procedure) and 67108-79 (for the second procedure), if the documentation indicates that both retinal detachments used the treatment method outlined by the descriptor for 67108. Remember that if you use modifier -79 (Unrelated procedure or service by the same physician during the postoperative period), either the second procedure must be linked to a diagnosis code different from the ICD-9 code linked to the initial procedure, or the second procedure must be performed on a different eye. Also, you should use eye modifiers (-LT and -RT) for services that are billed in the postoperative [...]