Ophthalmology and Optometry Coding Alert

Question: We had a patient with previous glaucoma surgery who lifted a very heavy object a few days after the surgery. Our physician then had to perform a reformation of the flat anterior chamber with choroidal drainage. Should we code this as 67015, and should any other code accompany it?

Pennsylvania Subscriber


Answer: Yes, you should use 67015 (Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach [posterior sclerotomy]). You can also use HCPCS J3490 (Unclassified drugs) for the viscoelastic substance.
 
If this is a Medicare patient, Medicare does not reimburse for postoperative care given in the office for a related condition. But if the surgical procedure requires a return to the operating room (OR), it is reimbursed if the service is billed with modifier -78 (Return to the operating room for a related procedure during the postoperative period).
 
Medicare defines the operating room setting: "An OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient's condition was so critical there would be insufficient time for transportation to an OR)."
 
Note: If this is a non-Medicare patient, check with the payer for billing and reimbursement guidelines for the injections.