Ophthalmology and Optometry Coding Alert

Question: We have an ophthalmic surgeon who performs cataract surgery and then turns the patients over to an optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?

Washington Subscriber

Answer: If the ophthalmic surgeon turns the patient over to an optometrist for all 90 days of postoperative care, append modifier 54 (Surgical care only) to the cataract surgery code (for example, 66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

The optometrist will report 66984 with modifier 55 (Postoperative management only) appended for 90 days of service.

If the surgeon turns over care to the optometrist immediately, the optometrist is responsible for postoperative management for the whole 90 days, regardless of when he first sees the patient.

Split care: If the ophthalmic surgeon does not transfer care immediately, he may report 66984-55 for however many days he remains responsible for postoperative management. The optometrist then reports 66984-55 for however many days remain in the 90-day global period.

Example: The patient has cataract surgery on the right eye on March 7. The 90-day global period for this surgery ends on June 5. The ophthalmic surgeon relinquished care on March 14. The optometrist first sees the patient on March 17.

The optometrist's postoperative care begins on March 15, even though he does not see the patient until March 17.

Because the surgeon did not relinquish care until the postoperative period was already in progress, he should code for seven days of postoperative care (March 8-14).

This leaves 83 days of postoperative care for the optometrist to report -- March 15 through June 5.

The ophthalmic surgeon should report 66984-54 and seven days of 66984-55. The optometrist should report 83 days of 66984-55.

Hidden trap: Although the optometrist's days of care start the day after the surgeon relinquished the patient's care, the optometrist should not actually submit a bill until he has done the first follow-up visit.