Ophthalmology and Optometry Coding Alert

When mistakes during surgery lead to extra work for the physician but do not harm the patient, ophthalmology coders are often confused about when they can and cannot bill. 
Medicare's rule on physician mistakes is addressed through its coding edits, but the overriding principle is that a physician cannot benefit financially from his or her errors. The coding edit system seeks to prevent payments to physicians for repair of their mistakes. But under certain circumstances, you may appropriately bill for such repairs.   When it's OK to Bill   The following are examples of when you can bill for errors.
Lens fragments: Sometimes during cataract surgery, lens fragments remain in the eye. This situation requires a return to the operating room for follow-up surgery to remove the lens fragments. The code for removing the fragments depends on their size, which typically dictates the removal techniques. For example, a small fragment can often be removed through a straightforward posterior vitrectomy (67036, vitrectomy, mechanical, pars plana approach). A large fragment may require phacofragmentation in addition to posterior vitrectomy, which requires the use of 67036 and 66850 (removal of lens material; phacofragmentation technique [mechanical or ultrasonic] [e.g., phacoemulsification], with aspiration) with modifier -51 (multiple procedures) appended.
The lens-fragment removal is billable only if a second physician performs the surgery. Usually a general ophthalmologist does the original cataract surgery, and a retina specialist performs the lens-fragment removal. 
If the retinologist who removes the lens fragment is in the same group as the physician who performed the initial cataract surgery, and the group uses a common provider number for billing, the retinologist should bill 67036 (or 67036 with 66850-51) with modifier -78 (return to the operating room for a related procedure during the postoperative period). If the retinologist is not in the same group as the original ophthalmologist, he or she does not need modifier -78. 
Retrobulbar injection only: Sometimes, a physician begins a procedure but cannot complete it. Do not automatically bill the procedure and append modifier -53 (discontinued procedure). Rather, report a code for the part of the procedure performed. A typical situation is a retrobulbar block (67500*, retrobulbar injection; medication [separate procedure, does not include supply of medication]). The ophthalmologist starts the block and then can't proceed due to hemorrhaging. Instead of billing for the whole procedure (which may be a cataract procedure, any oculoplastic procedure, or various other ophthalmological procedures requiring a local block), code only for the retrobulbar block. This allows billing the planned procedure at a later date when it is actually done, preventing denials because the payer did not understand why you billed the same procedure code(s) twice with different dates of service.  
Partial cataract [...]