Ophthalmology and Optometry Coding Alert

Question: A patient underwent a retinal repair in the right eye, then three weeks later returned with a retinal detachment in the left eye. Given that the left retina detached within the global period of the procedure on the right eye, how should I code these encounters?

Alabama Subscriber

Answer: Report the appropriate retinal detachment repair CPT® code – 67101-67105 (Repair of retinal detachment…) – with a modifier to code a repair of a recurrent retinal detachment when the definition of the code is met. If the surgeon performs the elements that are described in 67108 (Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique), for example, he should use that code to bill the service regardless of whether the surgery is subsequent to an initial 67108.

If a patient undergoes procedure 67108 in his right eye and three weeks later he returns with retinal detachment in his left eye, you can code both procedures with 67108 (for the first procedure) and 67108-79 (for the second procedure), if the documentation indicates that both retinal detachments used the treatment method outlined by the descriptor for 67108.

Do assign code 67108 with the LT or RT modifier when the second retinal detachment repair is performed if the second 67108 procedure is performed outside the 90-day global period of the initial 67108 procedure.

However: If a second detachment occurs in the same location as the first, your strategy will change. Example: A patient undergoes a retinal detachment repair, and just two weeks later that same patient returns because the retinal detachment recurs in the same location as the first.

Hidden Trap: Do not append modifier 58 (Staged or related procedure or service by the same physician or other qualified health professional during the postoperative period) to the retinal detachment repair code. Modifier 58 can’t be used simply because another procedure is being performed to fix the initial problem.

The correct modifier for a return to the OR within the global period is 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health professional following initial procedure for a related procedure during the postoperative period).