Ophthalmology and Optometry Coding Alert

Question: Our physician often injects 5FU following a trabeculectomy. How can I code the injection for reimbursement during the postoperative period?

Massachusetts Subscriber

Answer: The code for the injection can be handled one of two ways: 68200* (Subconjunctival injection) or 67515* (Injection of medication or other substance into Tenon's capsule) depending on the details of the service. But the separate procedure component present in both these codes poses a dilemma since it bundles them into the procedure itself, the trabeculectomy, 65850, which has a 90-day global period.

Some carriers may pay for the postoperative injection if modifier -58 is appended to the injection code, to represent that it was a staged procedure (planned prospectively or at the time of the initial procedure). The use of modifier -58 in this situation requires the physician to have clear preoperative documentation that the treatment plan includes 5FU, an antifibrotic agent that retards the formation of scar tissue at the wound site and injections.