Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist repaired a detached retina in the left eye. He used both cryotherapy and a laser for the repair. Should I report the procedure codes with modifier -51 (Multiple procedures) attached to the lesser-used method? Or will the second services reported be automatically denied because there is only one diagnosis code?

Virginia Subscriber

Answer: Once again CPT has managed to blur the guidelines for the proper use of multiple-procedure codes with confusing verbiage.

The two codes that describe the procedures performed are 61701 (Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid) and 67105 ( photocoagulation, with or without drainage of subretinal fluid).

To know how to bill these two procedures you need to access the Correct Coding Initiative (CCI) bundled-procedures list. 67101 and 67105 are listed as mutually exclusive codes, meaning if you bill both services to a payer that uses the CCI to process claims, like Medicare, they will select and pay only the lower of the two services. When billing for services that are mutually exclusive, you need to look up the services on your fee schedule and bill the one service that has a higher allowable amount.

When billing a payer other than Medicare, you can attempt to bill for both services, listing the higher service first with the appropriate eye modifier and the second procedure with modifier -51.

Answers to You Be the Coder and Reader Questions provided by Fiona Lange, CPC, with Danbury Eye Physicians in Danbury, Conn.; and Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.