Ophthalmology and Optometry Coding Alert

Question: How should we bill for the release of intra-vitreal gas done in the office?
      
Texas Subscriber

Answer: This is a complication of retinal repair and is not billable separately when performed in an office setting during the 90-day postoperative period. The surgeon must inject gas to hold back the retina when performing 67110 (repair of retinal detachment; by injection of air or other gas [e.g., pneumatic retinopexy]). If some gas is retained, causing an increase in intraocular pressure, the ophthalmologist must release it.  
 
There is additional payment for the release, as Medicare doesnt pay for treatment of complications outside of the operating room. If performed in the operating room, you could code 67015 (aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach [posterior sclerotomy]). Technically, there is no code for this. Code 67015 does not describe the release of gas. However, the code description is old and does not reflect new technology well.  
 
Code 67015 has an argument that can be made for its use. Whether the argument could be won with a carrier that took exception to the use of the code is unknown. Append modifier -78 (return to the operating room for a related procedure during the postoperative period).