Ophthalmology and Optometry Coding Alert

Question: I am trying to bill for the removal of sutures the ophthalmologist placed during a trabeculectomy. My initial billing was a 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: Sometimes, during a trabeculectomy, an ophthalmologist places a suture with the intention of cutting it during the postoperative period if the flow of fluid out of the eye is too restricted by the sutures.

Unfortunately, if you’re reporting this service to Medicare, you won’t see payment because it falls under Medicare’s global surgical package guidelines. You should not report suture removal to affect the flow following the trabeculectomy procedure to Medicare.

Explanation: The Medicare Claims Processing Manual states that the global package includes miscellaneous services — items such as dressing changes, local incisional care, removal of operative pack, removal of cutaneous sutures, lines, wires, tubes, drains, etc. For ophthalmology, this includes suture removal by any method.

Good news: You can separately report the needling of the bleb, 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure), using modifier 78 (Unplanned return to the operating/procedure room by the same physician or non-physician provider following initial procedure for a related procedure during the postoperative period), but only if the needling of the bleb was performed in an operating-room setting. If, however, the needling procedure took place in a non-operating-room setting — for example, in the office or minor procedure room — you cannot separately report the procedure.

Caution: Some coders bill for the removal of the sutures by using 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) appended with modifier 78. Even though some carriers may pay for this, it is not correct coding and you shouldn’t code this way.