Ophthalmology and Optometry Coding Alert

Question: On Sept. 15, the ophthalmologist performed focal laser surgery on the area of edema in the left eye. On Oct. 15, the patient returns for a postoperative visit, and the ophthalmologist performs another focal laser treatment for an area of edema that has appeared in the same eye. What should I report for the Oct. 15 procedure?

South Carolina Subscriber

Answer: You would not code for the second procedure. Subsequent treatments of CPT^® 67210 (Destruction of localized lesion of retina [e.g., macular edema, tumors], 1 or more sessions; photocoagulation) or 67228 (Treatment of extensive or progressive retinopathy, 1 or more sessions; [e.g., diabetic retinopathy], photocoagulation) on the same eye within the 90-day global surgical period are not separately billable, due to the “one or more sessions” verbiage in the code description.

However: When a subsequent treatment within the postoperative period is in a different eye, you should code and bill this service with modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period).

In this scenario, if the patient returns a month after an initial treatment with 67210 of the left eye, and the physician notices that the right eye has developed retinal edema and performs focal laser treatment in that eye, you would report 67210-79-RT. Modifier 79 indicates that this procedure is unrelated to the first procedure; the diagnosis and treatment are the same, but the eye is different.

Opportunity: Each line item should get modifier 79 if the surgeon performs more than one unrelated procedure.

Don’t miss: As is the case with modifier 79, the eye modifiers (LT and RT) are crucial. If modifier LT had not been used for the first procedure and modifiers 79 and RT used for the second procedure, the second procedure would look like an additional treatment on the same eye to Medicare and would be denied.