Ophthalmology and Optometry Coding Alert

Question: I am trying to bill a revision for a trabeculectomy. I coded the initial procedure as 66170. What code and what modifier should I use? The revision is taking place within 30 days of the initial surgery by the same physician. Florida Subscriber

Answer: The answer depends on whether your ophthalmologist performed the revision in the office or required a return to the operating room (OR). For revision procedures provided in the office, Medicare considers the revision part of the post-op care, and you cannot separately bill for it. For revision requiring a return to the OR, you should report 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure), according to most payers. 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 indicate that the procedure falls within the global period of the original surgery.