Ophthalmology and Optometry Coding Alert

Question: I am trying to bill for the removal of sutures the ophthal­mologist placed during a trabeculectomy. My initial billing was 66170. What code and what modifier should I use now? The revision is taking place within 30 days of the initial surgery by the same physician.

AAPC Forum Participant

Answer: Trabeculectomy is a type of glaucoma surgery that creates a new pathway for fluid inside the eye to be drained — the diverted aqueous humor accumulates and forms an elevated subconjunctival fluid-filled pocket called a bleb. Sometimes, the ophthalmologist places a suture to adjust the amount of aqueous humor that egresses, when necessary. If the flow of fluid out of the eye is too restricted, the suture can be cut.

Unfortunately, if you’re reporting this part of a trabeculectomy service to Medicare, you won’t see payment because the suture removal falls under Medicare’s global surgical package guidelines. You should not report suture removal to affect the flow following the trabeculectomy procedure to Medicare.

Explanation: The Medicare Claims Processing Manual states that the global package includes miscellaneous services — items such as dressing changes, local incisional care, removal of operative pack, removal of cutaneous sutures, lines, wires, tubes, drains, etc. For ophthalmology, this includes suture removal by any method.

The AMA has also weighed in on the matter: “During the postoperative period, one or more releasable sutures may be removed at a time, depending on the adequacy of the bleb’s function. Suture removal is included and is not reported separately by the physician,” per CPT^® Assistant (Volume 13, Issue 7)

Caution: Some coders bill for the removal of the sutures by using 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician … following initial procedure for a related procedure during the postoperative period). Even though some carriers may pay for this, it is not correct coding, and the payer could later recoup payment.