Ophthalmology and Optometry Coding Alert

Question: A patient had cataract surgery, and in the middle of surgery something happened and the doctor was unable to complete it. Can I still charge?

California Subscriber

Answer: Modifier -53 (discontinued procedure) is the correct modifier to append if you have discontinued surgery. Anesthesia must have been administered to use this modifier. In addition, if there is a CPT code or codes that describe what was done prior to the procedure being discontinued, they should be used instead of the original surgical code with the -53 modifier.

As an example, if the physician performed only a retrobulbar injection, he or she would code 67500* (retrobulbar injection; medication [separate procedure, does not include supply of medication]). Or if the physician was able to remove the cataract but had to discontinue the procedure before placing the new lens, you would use 66850 (removal of lens material; phacofragmentation technique [mechanical or ultrasonic] [e.g., phacoemulsification], with aspiration). At a later date, when the physician was ready to place the IOL you would bill the second procedure, 66985 (insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) with modifier -58 (staged or related procedure or service by the same physician during the postoperative period). The procedures would meet the guidelines of modifier -58 because the second procedure was planned at the time of the first procedure. If there is not a definitive code for what was performed prior to the procedure being discontinued, you would submit the intended procedure 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) with modifier -53, an operative note and a cover letter. In the cover letter, list a percentage of the procedure completed, such as, The procedure was 50 percent completed. The medical records will go to a nurse reviewer who may or may not have ophthalmology experience, so you need to help the carrier. You are not required to reduce your fee, although you should consider the public relations effect of not reducing the fee, especially if you plan to return to the operating room. to complete the intended procedure. Also, reducing the fee to reflect the work accomplished is ethical billing.