Ophthalmology and Optometry Coding Alert

Question: We did a routine cataract procedure in which the lens implant was damaged and could not be implanted. There was no backup lens. We ordered the lens and did the implantation the next day. What is the proper way to code for the procedures? Which modifiers come into play?

Mississippi Subscriber

Answer: Medicare has strict rules regarding reporting repeat surgeries for reasons such as physician mistakes. However, there are certain circumstances in which you should bill twice for the procedure.

You should be able to receive reimbursement for partial cataract operations. For example, the physician preps a patient for cataract extraction with intraocular lens (IOL), which usually corresponds to 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]). The ophthalmologist removes the cataract but decides against the IOL insertion because the lens is damaged. You should bill with the code that represents the method of extraction, such as phacofrag-mentation (66850), with the appropriate eye modifier.

When the ophthalmologist implants the IOL at a later date that is within 90 days of the first procedure, you should append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to the surgical code 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) to indicate a staged procedure.

You should always select the code that best fits the procedure performed, regardless of the original plan. When you stray from standard procedures due to unavoidable errors or problems, do not file for the planned procedure if there is a CPT code that describes what was performed prior to the surgery being discontinued. If a code does not exist to encompass the work that was performed, then the planned procedure code can be billed with modifier -53 (Discontinued procedure). Your carrier may want to review the operative report associated with the discontinued procedure to determine how to pay your claim.