Ophthalmology and Optometry Coding Alert

Question: Medicare instructed me to use modifier -58 for YAG in the postoperative period of cataract removal, but I don't think it is really appropriate. Is -58 really the appropriate modifier or is this inaccurate information?

Virginia Subscriber

Answer: There must have been some sort of miscommunication for Medicare to recommend modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) for a postoperative YAG procedure, 66821 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; stab incision technique [Ziegler or Wheeler knife]) - but only because the YAG procedure followed cataract surgery, a procedure considered more complicated than YAG.

You would be correct in appending modifier -58 if the second procedure had been "greater" than the first. Because YAG is considered a lesser procedure than cataract removal, the appropriate modifier is -78 (Return to the operating room for a related procedure during the postoperative period).

Be sure to include thorough documentation of medically necessity when performing YAG after cataract removal. Carriers can be wary of these claims, especially when they are within the 90-day global period.

- Answers to You Be the Coder and Reader Questions provided by L. Heath Pridgeon, clinical and reimbursement specialist at an ophthalmology clinic and ambulatory surgery center in Florida; and Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.