Ophthalmology and Optometry Coding Alert

Question: How do we bill for cleaning up with a vitrectomy (67010) after cataract surgery (66984)? Can we use modifier -59?

Mississippi Subscriber

Answer: No, you cant use modifier -59 (distinct procedural service). To bill 66984 and 67010 together with modifier -59 you must perform the vitrectomy for a different reason than the cataract surgery. If the cataract surgery itself resulted in the need for the vitrectomy, as cleaning up implies, it would not be appropriate to bill each as separate services. Use modifier -59 when the vitreous prolapse exists prior to cataract surgery and you have listed both diagnoses preoperatively. Also, document both procedures as planned, with the same information documented in the impression and treatment plan. (For more on vitrectomies and cataract surgeries, see 66982 article on page 44.)