Ophthalmology and Optometry Coding Alert

Question: After a pterygium removal, the patient's conjunctival allograft dislocated. The ophthalmologist repositioned and sutured the conjunctival graft. Should I use 66250? Do I need a post-op modifier?


Florida Subscriber

Answer: Yes. CPT code 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) describes the repair the ophthalmologist performed. Because 66250 is not bundled into the pterygium removal code, you won't need a modifier. If the ophthalmologist feels that his work was more extensive than 66250 describes, you could report 66999 (Unlisted procedure, anterior segment of eye). Reporting the unlisted-procedure code requires you to submit the operative report, and the claim will go through a review with the carrier.

Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.