Ophthalmology and Optometry Coding Alert

A new modifier in CPT 2001 will increase reimbursement for ophthalmologists. The description of modifier -60 indicates a way to be paid for performing complex surgery or for performing surgery on a significantly altered field:


Altered Surgical Field: Certain procedures involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation, or distorted anatomy, irradiation, infection, very low weight (i.e., neonates and small infants less than 10 kg) and/or trauma (as documented in the patients medical record). These circumstances should be reported by adding the modifier -60 to the procedure number or by use of the separate five-digit modifier code 09960. Note: For unusual procedural services not involving an altered surgical field due to the late effects of previous surgery, irradiation, infection, very low weight (i.e., neonates and infants less than 10 kg) and/or trauma, append the modifier -22 or use the separate five-digit code 09922.


Modifier -60 could apply when the patient has had previous intraocular surgery, and residual effects complicate the current surgery, explains Lise Roberts, vice-president of Health Care Compliance Strategies, a coding and compliance consultant based in Jericho, N.Y. When this modifier refers to an altered surgical field, it is referring to the surgical site, not the sterile field. Therefore, it will certainly apply to the new complicated cataract surgery code.

It is uncertain whether HCFA has determined -60 to be a payment modifier or an information modifier, Roberts says. My guess would be that until they have some experience with it, it will function as an information modifier that triggers normal payment but not additional payment.

With the exception of specific codes for complicated cases such as the cataract code, other procedures complicated by altered surgical fields will require additional information (e.g., the operative report) to process them for additional payment, Roberts adds.

Thus far, HCFA has not issued any instructions to carriers about handling claims for modifier -60. Ophthalmology Coding Alert will keep you up-to-date on this issue as more information arrives.