Ophthalmology and Optometry Coding Alert

You Be the Coder:

Modify Multiple Glaucoma Surgery Coding

Published on Sun Dec 01, 2002

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: My physician performed a laser trabecu-loplasty for glaucoma in a patient's left eye. One week later the patient returned for the physician to monitor his progress, and my physician decided the procedure was unsuccessful. He performed an iridotomy in a second attempt to lower the intraocular pressure of the patient's left eye. Which modifier do I need to append to the iridotomy to be reimbursed?

Anonymous Subscriber

Answer: This scenario should be coded 65855-LT (Trabeculoplasty by laser surgery, one or more sessions [defined treatment period]) for the first surgery and 66761-58-LT (Iridotomy/iridectomy by laser surgery) for the second surgery because the trabeculoplasty was performed first and the iridectomy was performed in the postoperative period. But if the order of the procedures were to be reversed, modifier -78 (Return to the operating room for a related procedure during the postoperative period) would apply. Let's see why.

The different guidelines associated with modifiers -58 (Staged or related procedure or service by the same physician during the postoperative period) and -78 ultimately determine whether they apply to a second glaucoma surgery in the postoperative period of the initial surgery.

Modifier -58 is most appropriate in this case because an iridotomy is considered a more extensive procedure than a trabeculoplasty. And according to Medicare's global surgery policy, modifier -58 should be used for three types of subsequent procedures:

One "planned prospectively at the time of the original procedure"

One "more extensive than the original procedure" (the less extensive procedure failed)

One "for therapy following a diagnostic surgical procedure."

A note to coders: You can bill only one laser procedure of the same code in a 90-day period on the same eye because these codes are defined as for one or more treatments. Therefore, modifiers -58 and -78 do not apply if the physician performs the laser trabeculoplasty, 65855, for example, as the initial procedure and another laser trabeculoplasty as a subsequent procedure. The same rule applies to the iridotomy code, 66761.

Coders should also be aware of Medicare's adjustment of laser trabeculoplasty's postoperative period, which has been changed from 90 days to 10 days as of Jan. 1, 2002.

If the second procedure performed did not meet the requirements of modifier -58, then modifier -78 would apply as a related procedure performed during the postoperative period that required a return to an operating-room setting. Medicare considers the room in which a laser machine is used an operating-room setting even if it is a portable laser.