Ophthalmology and Optometry Coding Alert

Question: A patient came to the office presenting with bilateral closure glaucoma, more severe in the left eye than the right eye. The doctor completed the iridotomy on both eyes. The patient then went to the emergency department for evaluation. After performing one last intraocular pressure check prior to discharging the patient, the ophthalmologist found that the intraocular pressure in her left eye had again risen. He performed an emergency trabeculectomy. What would be the proper modifier for 66172? Would -76 work, since it was in the same day?

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.