Ophthalmology and Optometry Coding Alert

Question: How should we bill for in-office repositioning of an intraocular lens (IOL) that took place in the postoperative period?

Connecticut Subscriber

Answer: The answer depends on whether the initial procedure performed related to the placement of an IOL. If the initial procedure was cataract surgery, repositioning the IOL, when done in the office and not in what Medicare considers an operating room setting, is part of your global fee, and you cannot bill for it within 90 days of the surgery. If, however, you perform the repositioning in the operating room within the postoperative period of cataract surgery, you can bill 66825 (repositioning of intraocular lens prosthesis, requiring an incision [separate procedure]) with modifier -78 (return to the operating room for a related procedure during the postoperative period).

Medicare has defined an operating room setting as a place specifically equipped and staffed for the sole purpose of performing procedures. This could include a laser suite. It would not include a minor treatment room.

If the initial procedure was not related to the IOL, and a pre-existing IOL needed repositioning, you could bill for the repositioning done in the office with (66825) with modifier -79 (unrelated procedure or service by the same physician during the postoperative period).

The diagnosis code for the repositioning is 996.53 (mechanical complications of other specified prosthetic device, implant, and graft; due to ocular lens prosthesis).