Ophthalmology and Optometry Coding Alert

Appending the wrong modifier may torpedo your claims

Ophthalmology coders are likely to code cataract procedures more often than any other surgery. But with over $900 at stake for complex cataract procedures in 2006, you need to be sure you're coding correctly every time. Take this quiz to make sure you're on the right track. Note: You can find most of the information in "Crack These Confounding Cataract Coding Conundrums" in the February 2006 Ophthalmology Coding Alert.

Question 1: An ophthalmologist performs a complex cataract removal with IOL insertion on a patient's left eye. Thirty days later, he performs the same surgery on the patient's right eye. How should you code the right eye procedure?

A: 66982-RT

B: 66982-59-RT

C: 66982-78-RT

D: 66982-79-RT

E: 66982
 
Question 2: The cataract patient in Question 1 returns 70 days after the cataract surgery on his right eye. The ophthalmologist finds after-cataracts in the right eye, and incises the posterior capsule with a YAG laser. How should you code this procedure?

A: 66821

B: 66821-RT

C: 66821-78-RT

D: 66821-79-RT

E: 66821-55

Question 3: If the above patient had returned at the same time with after-cataracts in his left eye instead of his right eye, what code should you report?

A: 66821-79-LT

B: 66821-LT

C: 66821-78-LT

D: 66821

E: 66821-55

Question 4: In another case, the ophthalmic surgeon sees the patient on the 24th day after the surgery and refers the patient to an optometrist for postoperative care.  The optometrist first sees the patient on the 36th day after surgery. How many days of postoperative care should you report for the ophthalmic surgeon?

A. 0 days

B: 24 days

C: 25 days

D: 66 days

E: 90 days

Quiz Answers

Question 1: D. Code 66982-79-RT (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one-stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex ...; unrelated procedure or service by the same physician during the postoperative period; right side).
 
The cataract surgery the ophthalmologist performed on the left eye has a 90-day global period, so a modifier is necessary to report the surgery on the right eye. Modifier 78 (Return to the operating room for a related procedure during the postoperative period) is not appropriate, because the cataract in the right eye is not truly related to the cataract in the left eye, says Saul Yhanes, CPC, coder and collections specialist for the Bascom Palmer Eye Institute at the University of Miami. Modifier 59 (Distinct procedural service) is used to distinguish a procedure performed on the same day as another procedure, not during the postoperative period.

Question 2: C. In this scenario, the patient is out of the 90-day global period for the surgery on his left eye ...quot; but he is still within the global period for the surgery on his right eye. When the ophthalmologist performed 66982-79-RT 70 days ago, a new 90-day global period started, says Nancy Cockrell, CPC, OCS, insurance manager at Jackson Eye Associates in Jackson, Miss.
 
Code 66821-78-RT (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]) for the after-cataract procedure.

In this case, the procedure is clearly related to the cataract surgery on the right eye, making modifier 78 appropriate. Modifier 55 (Postoperative management only) is not appropriate, since the ophthalmologist is not just providing postoperative care.

Question 3: A. If the patient returns 100 days after the cataract surgery on his left eye, the global period for 66982-LT would already have expired. But the patient is still within the global period for 66982-79-RT, so a modifier is necessary. Since the after-cataracts in the left eye are unrelated to the cataracts in the right eye, append modifier 79.

Question 4: B. The ophthalmic surgeon provided 24 days of postoperative care. The day the ophthalmic surgeon transferred the patient's care by referring him to the optometrist was the last day of his period of postoperative care.
 
The optometrist may code for all the days he was responsible for the patient's care, starting from the day the surgeon transferred care, including any days prior to the first day the optometrist actually saw the patient ...quot; in this case, 66 days. (However, the optometrist should not submit a claim to Medicare for postoperative care until after he actually sees the patient in his office.)
 
For split-postoperative care, report 6698x-54 (Surgical care only) for the surgical procedure, then report 24 days of 6698x-55 (Postoperative management only), says Raequell Duran, CPC, president of Practice Solutions in Santa Barbara, Calif. The optometrist will report 66 days of 6698x-55.