Ophthalmology and Optometry Coding Alert

Question: A patient returned during the 90-day postoperative period of a focal laser for a repeat laser due to the eye still bleeding. Should I use modifier 58 or 78 with 67210?

Pennsylvania Subscriber

Answer: You should not use 67210 (Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation) again during the same 90-day period, even with modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) or modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). The code’s descriptor specifies “one or more sessions,” plural. The AMA considers the code for retina lasers to be a repeat service or a series treatment. The Medicare Physician Fee Schedule assigns the code a 90-day global period, so all repeat treatments during that period are included and not separately billable.

Do track repeat sessions, but do not submit a bill for the treatment. You can use 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure) or another internal tracking-only code with a message of “included repeat session” if you want to track these services.