Ophthalmology and Optometry Coding Alert

Question: If Dr. A performs cataract surgery, and the next day Dr. B performs a posterior vitrectomy and removes some retained lens material due to complications from the cataract surgery, and Dr. A assists Dr. B in that, how should we code for Dr. A? (They are not in the same group.)

Texas Subscriber

Answer: Dr. A. would use modifier -80 (assistant surgeon) appended to either 67036 (vitrectomy, mechanical, pars plana approach) or 66852 (removal of lens material; pars plana approach, with or without vitrectomy) for the second day. The code for the vitrectomy (67036) and lensectomy depends on the amount of retained lens material and the techniques necessary to remove it.

The posterior vitrectomy (67036) would be used if the lens material had dropped to the back of the posterior chamber making a posterior vitrectomy necessary. If the lens material is small and removed by use of the vitrector, no separate code is used for its removal.

If the lens material is large and phacofragmentation is necessary to remove it, 66850 (removal of lens material; phacofragmentation technique [mechanical or ultrasonic] [e.g., phacoemulsification], with aspiration) would be used in addition to 67036.

However, if the lens material is not far from its original position and only a partial posterior vitrectomy is necessary to remove it, use 66852, which includes both the vitrectomy and lensectomy.

If Dr. B uses a second code for the lensectomy, Dr. A may not append -80 to that service because an assistant is not authorized for the lens removal codes in the Medicare program. Dr. B would also append modifier -51 (multiple procedures) to 66850, if used, and modifier -78 (return to the operating room for a related procedure during the postoperative period) for both. Dr. As claim for the second day would look like:

67036-80-78 or
66852-80-78.


Answers to You Be the Coder and Reader Questions are contributed by Lise Roberts, vice president of Health Care Compliance Strategies, interactive compliance training consultancy based in Jericho, N.Y.; and Raequell Duran, president of Practice Solutions, ophthalmology coding, compliance and reimbursement consultancy in Santa Barbara, Calif.