Ophthalmology and Optometry Coding Alert

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.