Billing for Unrelated Problem Discovered by Other Physician During Postop Period
Published on Tue Jun 01, 1999
The following question comes from Ron D. Frame, OD, of Optometric Physicians of Parkersburg, a six-optometrist practice in Parkersburg, WV. An OD refers a patient for cataract surgery to an MD, which he completes and bills to Medicare under the split -55 modifier (postoperative management only). Then, during the postop period for which the OD is responsible, he discovers a trichiasis (67820) in the same eye. How should that be billed?
The answer is to use the code for the trichiasis
epilation (67820) with an office visit (99201-99205 or 99211-99215) and the -24 modifier (unrelated E/M service by the same physician during a postoperative period) appended to the office visit, says Barbara Gault, insurance clerk for Halpern Eye Associates, a five-optometrist practice in Dover, DE. We do postop management for cataract surgery frequently, says Gault. To get the postop portion of the global fee, we bill 66984-55 (extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique), says Gault. But then, if the patient comes in during the 90-day period and there is another problem, we would usually bill for an office visit with the -24 modifier and an eye modifier (-LT or -RT), she says. Since the trichiasis epilation (67820) is a starred procedure, this code only covers the procedure itself, so you would be able to charge an office visit. And the modifier -24 would go on the office visit. For example, in the trichiasis example, if the problem were in the left eye, you might have 99213-24-LT in the top line, and 67820 in the second line. Trichiasis is clearly unrelated to cataract surgery, regardless of which eye it is in.