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Ophthalmology and Optometry Coding Alert

Reader Question:

Simplify Reporting Post-Op Procedures

Published on Mon Nov 24, 2003

Question: One of our ophthalmologists did a TPPV for retinal detachment, 67108, and inserted a gas bubble into the eye. While the patient was still in post-op, the doctor did paracentesis (65805) in the same eye because the patient had elevated IOP due to the gas bubble. Is there a DX code for this? If so, is this something I can bill for?
      
Tennessee Subscriber
 
Answer: The answer depends on what type of insurance the patient has and will probably be "No" in most cases. In the Medicare program, you can't bill for a procedure done in the office to manage a complication of surgery because it's part of the global surgical package.    

Medicare only allows additional reimbursement if the complication the physician is treating required a return to an OR setting.
 
Most typically, paracentesis is performed with a small blade in the examination room or in the minor- surgery room. 
 
Neither of those location qualifies as an "operating room setting" in the Medicare program. Without meeting that criterion, the procedure would be considered post-operative care and included in the payment you received for the initial surgery. 
 
For insurance companies other than Medicare, you can try to bill the procedure with the appropriate eye modifier, -RT or -LT, with the diagnosis of 998.9 (Unspecified complication of procedure, not elsewhere classified; postoperative complication NOS).
 
Because it's a complication of surgery, a payer other than Medicare will most likely deny the service as well.

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