Ophthalmology and Optometry Coding Alert

After cataract surgery, patients may notice floaters or spots in their vision that they have not seen before. Lens material or lens fragments left in the eye after surgery may be the reason for this problem. Usually the ophthalmologist will schedule the extraction for a later date to prevent trauma to the eye and to have a chance to discuss the procedure with the patient. You can bill for taking the patient back to the operating room to remove the fragment and improve vision.

If the removal is because of a complication, you can get paid for going back, says Sharron Stevens, CPC, CCS-P, coding and reimbursement specialist for East Tennessee State University in Johnson City, Tenn. As long as you use modifier -78 (return to the operating room for a related procedure during the postoperative period), you will be paid during the global period for the cataract surgery.

Coding for Lens Fragment Removal

Depending on where the lens fragment is, code the appropriate vitrectomy procedure used for the removal, explains Raequell Duran, president of Practice Solutions, a Santa Barbara, Calif.-based coding and reimbursement consultant. For an anterior approach with partial removal, use 67005 (removal of vitreous, anterior approach [open sky technique or limbal incision]; partial removal). For an anterior approach, subtotal mechanical, use 67010 (removal of vitreous, anterior approach [open sky technique or limbal incision]; subtotal removal with mechanical vitrectomy). If you perform a pars plana vitrectomy to remove the fragment, use 67036 (vitrectomy, mechanical, pars plana approach). Append modifier -78 to the surgical procedure code.

If you remove the lens fragment during the cataract surgery itself, however, you cannot bill an additional amount. If you notice the fragment during the procedure and perform the vitrectomy at that time, then the vitrectomy is bundled into the cataract surgery, says Duran. The only time you can bill for a vitrectomy done at the same time as the cataract surgery is for an anterior vitrectomy (67010) when the patient has a pre-existing prolapsed vitreous or for a pre-existing posterior segment condition warranting posterior vitrectomy (67036). Medicare does not want to pay for the surgeon to clean up leaks in the vitreous in addition to paying for the cataract surgery thats why the two procedures are bundled.

If the vitrectomy is performed due to iatrogenic complications, it is not billable in addition to the cataract surgery in the Medicare program, says Duran. CPT codes 67005 and 67010 are considered components of the cataract removal code 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) on the Correct Coding Initiative (CCI) bundle list.