Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performed a complex cataract removal with IOL insertion on a patient’s left eye. Thirty days later, he performed the same surgery on the patient’s right eye. He returned 70 days after the cataract surgery on his right eye. The ophthalmologist found after-cataracts in the right eye, and incised the posterior capsule with a YAG laser. Which codes can we report for this final service without bumping up against global billing issues?

Pennsylvania Subscriber

Answer: In this scenario, the patient is out of the 90-day global period for the surgery on his left eye, but he is still within the global period for the surgery on his right eye. When the ophthalmologist billed 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation) with modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) and modifier RT (Right side) 70 days ago, a new 90-day global period started.

You’ll report 66821-78-RT (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery (eg, YAG laser) (1 or more stages); Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) 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. However, always be sure that the place of service is appropriate, since the description reads “return to the operating/procedure room.” If this service is performed in the office setting, the procedure must be performed in a dedicated procedure room, minor operating room, or other location to qualify for the use of the 78 modifier.