Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performed a YAG procedure on a patient's left eye, and one week later the same patient underwent a cataract extraction on his right eye. Do I need to put a modifier on the cataract extraction?

Georgia Subscriber

Answer: Even though you are aware that the procedures were performed on separate eyes, you are going to need to make that absolutely clear to your insurance carriers, which means you will need to append a modifier to the cataract extraction procedure.

Use modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to indicate that the cataract extraction, though performed during the 90-day postoperative period of the YAG capsulotomy, was not related to the original procedure.

Don't forget that none of the postoperative visits that are related to either the YAG capsulotomy or the cataract extraction can be billed within 90 days of each procedure because they are included in the surgical package.

However, if the patient presents with a problem unrelated to either procedure, you can bill the office visit as long as you append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period).