Vermont Subscriber
Answer: Modifier -76 (Repeat procedure by same physician) would not be appropriate. Your ophthalmologist did not repeat the iridotomy procedure in the ED; in this case, he performed an entirely different, and more complex, procedure. Code the procedure 66172-58 (Fistulization of sclera for glaucoma; trabe-culectomy ab externo with scarring from previous ocular surgery or trauma [includes injection of antifibrotic agents]; Staged or related procedure or service by the same physician during the postoperative period).
Modifier -58 is a cherished modifier because it involves no payment reduction. You can use modifier -58 only if any one of three conditions is met:
1. the subsequent procedure was "staged," or planned at the time of the original procedure
2. the subsequent procedure was more extensive than the original procedure (which is the case here, with a trabeculectomy following an iridotomy)
3. the subsequent procedure was for therapy following a diagnostic surgical procedure.