Ophthalmology and Optometry Coding Alert

Question: On June 1, our ophthalmic surgeon performed an extracapsular cataract removal with IOL insertion on a patient’s right eye. One month later, on July 1, he performs the same surgery on the patient’s left eye. I know the cataract procedure has a 90-day global period. What modifier should I use for the surgery on the left eye so I can report it within the global period of the surgery on the right eye?

West Virginia Subscriber

Answer: The cataract procedure, CPT^® 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]), does indeed have a 90-day global period, and you will need a modifier to report the code again within that 90-day period.

Because the two surgeries seem related, you may be tempted to append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to the second cataract surgery, but that would be a mistake. The surgery in the left eye is unrelated to the initial surgery in the right eye.

The best option here would be modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period).

Remember also to append the “side” modifiers, LT (Left side) or RT (Right side), to demonstrate that the ophthalmologist performed the procedures on opposite eyes. Report 66984-RT for the first surgery and 66984-79-LT for the second cataract surgery.

Reimbursement for 66984 would be about $650.40, based on 18.10 relative value units (RVUs) multiplied by the 35.9335 conversion factor.