Ophthalmology and Optometry Coding Alert

After removing remnants of a previous cataract surgery, some ophthalmologists dont bill for the second procedure. Too often, they lose revenue to which they are entitled. How should you code removal of retained nuclear material in the anterior chamber during the post-op cataract period? Diagnosis code 998.82 (cataract fragments in eye following cataract surgery) should be used along with billing code 67036-78.

If the second procedure was due to a complication because the doctor didnt get it all the first time, you would have to use modifier -78 (return to operating room for a related procedure during the postoperative period) on the second procedure, says Connie Selby, billing manager for Jay C. Grochmal, MD, and Dean S. Glaros, MD, an ophthalmology practice in Baltimore, MD. Yes, you can bill for going back in, but you would have to indicate that it was for a complication, she says.

You need modifier -78 since the second procedure is directly related to the first, agrees Margaret Mac, CMM, CPC, billing manager for Florida Eye Center
in St. Petersburg.

The service should be billed as a pars plana vitrectomy, 67036, because much of the vitreous is removed in order to reach the retained lens material and remove it, explains Lise Roberts, vice president of Health Care Compliance Strategies, a compliance and reimbursement consultant firm based in Syosset, NY. Because it is most often the case that the lens material can be removed using the same method as for removing the vitreous, typically no other code is used. The removal of retained lens nuclear material is what some people refer to as removal of lens remnants, she says. The center of the cataract is the nucleus center, which is dense and hard. Around it is the cortex, which is softer. The remnants are usually pieces of nucleus that were too dense to get out during the first procedure.

What diagnosis code would you use? Use 998.82 (cataract fragments in eye following cataract surgery), urges Roberts. This diagnosis code reflects the reason for returning the patient to the operating room.

Both coders note that some ophthalmologists perform the second procedure without billing it at all. But you can legitimately bill for this procedure just as you can bill for any complication that requires returning the patient to an operating room within the 90-day follow-up period of the first procedure.