Ophthalmology and Optometry Coding Alert

Question: Medicare is denying payment for cataract surgery on the second eye. I learned a while ago that if I had four modifiers to append to a CPT code, to put modifier -99 in the last modifier box and note "additional modifiers" in box 19 of the billing form. Since we're in a rural HPSA, we're appending modifier -QB to the code. I'm filing the second eye with 66984-QB-54-99, and additional modifiers -79 and -LT.

Mississippi Subscriber Answer: Modifier -99 (Multiple modifiers) was required in the past when you needed to list more than two modifiers with a CPT code. Now, most carriers have updated their claims processing systems and can recognize four modifiers in the modifiers field.

Tactic: Check with your software company and your carrier to see if you can report all four modifiers instead of appending modifier -99. If so, report 66984-79-54-QB-LT (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique; unrelated procedure or service by the same physician during the postoperative period; surgical care only; physician providing service in a rural HPSA; left eye).

Another way: Bill 66984-99 and list "-79-54-QB-LT" in the comments area or box 19. 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.