Ophthalmology and Optometry Coding Alert

Question: How can we receive ethical reimbursement for a (dacryocystorhinostomy)DCR  (68720) with tubes (for lacrimal fistula)? This is a very time-consuming procedure. In fact, our physician could perform five phacos (66984) in the time it takes to do one DCR, and Medicare pays less for a DCR than for a phaco.

New Jersey Subscriber

Answer: Code 68720 (Dacryocystorhinostomy [fistulization of lacrimal sac to nasal cavity]) is the correct code for the procedure described. Use modifier -22 (Unusual procedural services) to indicate that extra work was done. You will have to file the claim on paper. If the procedure took twice as long to perform as it normally would, double your fee.
 
Your comparison of fees shows why oculoplastics experts usually perform these procedures, rather than general ophthalmologists. If the procedure takes extra time due to a physician's inexperience, you may not use modifier -22.