Ophthalmology and Optometry Coding Alert

Question: After a pterygium removal, the patient's conjunctival allograft dislocated. The ophthalmologist repositioned and sutured the conjunctival graft. Should I use 66250? Do I need a post-op modifier?

Florida Subscriber

Answer: Yes, CPT® code 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) describes the repair the ophthalmologist performed. If the service occurs at the same surgical session as the pterygium removal, you won't need a modifier, because 66250 is not bundled into the pterygium removal code. If the ophthalmologist feels that his work was more extensive than 66250 describes, you could report 66999 (Unlisted procedure, anterior segment of eye).

Alternatively, you can append modifier 22 (Increased procedural services) to the code if the documentation supports a more extensive, complicated service. Reporting the unlisted-procedure code or appending modifier 22 requires you to submit the operative report, and the claim will go through a review with the carrier.

However, if the problem occurred during the post-op period as is implied in your question, be sure to report the revision code with modifier 78 (Unplanned return to the operating/procedure room by the same physician ...).