Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist covers for another ophthalmologist. He sees a patient who had surgery and needs to resuture because the suture site opened up. Can we bill for this, or is this considered post-op care and non-billable?

Wisconsin Subscriber

Answer: Since your physician is covering for the patients treating physician, he is treating the patient under the same package provided the service is being rendered within that time frame. If the procedure had a 90-day global period, and the resuturing of the surgical wound takes place within that period, it would not be billable. However, if the wound requires repair after 90 days, then the wound repair would be a billable service for whatever type of repair was performed. When the physicians covers for the surgeon, he or she is acting as the surgeon and is subject to the 90-day global period. Within the 90-day global period, when treating a complication of the surgery, only those services that require a return to the operating room setting can be billed and paid for in addition to the global surgical package, or fee for the initial surgery. Medicare considers the operating room setting to be a hospital operating room, ambulatory surgical center (ASC), or dedicated laser suite. The minor room and patient lane are not considered an operating room setting.

If the resuturing required a hospital operating room or ASC setting, the service could be billed with 66250 (revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure). The modifier -78 (return to the operating room for a related procedure during the postoperative period) should be appended to the surgical code 66250.