Ophthalmology and Optometry Coding Alert

Question: One week ago, an ophthalmologist in our practice performed a trabeculectomy on a patient. Then today, the patient came to our office with elevated intraocular pressure and a failing bleb. The doctor injected 5-FU near the bleb site in our office. Can I code for the injection?

New Hampshire Subscriber

Answer: Unfortunately, you won't get paid for administering the injection because the patient was still within the trabeculectomy's global period.

Why: Medicare's global surgery package includes all related services required of the ophthalmologist during the surgery's postoperative period performed in the office when complications do not require additional trips to the operating room.

Therefore, you shouldn't file a claim for administering the injection because the ophthalmologist did not have to return the patient to the operating room. Without a modifier, the carriers will bundle the injection with the original trabeculectomy.

Avoid 58: Using modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) is not appropriate because the physician did not plan or stage the injection.

Remember: You can still code for the 5-FU supply with J9190 (Fluorouracil, 500 mg).