Wiki Cataract surgery both eyes.

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I respectfully disagree with the previous reply.

The eyes are separate anatomical sites. Therefore, if you bill a cataract on both eyes on the same day (please document why its being done on the same day) then you need to use a 79 modifier.
 
The 79 is incorrect for a procedure performed bilateral in the same session. The 79 is a return to the OR in the post operative period for unrelated procedure. The 50 modifier or two lines with RT then LT is correct.
 
mitchellde said:
The 79 is incorrect for a procedure performed bilateral in the same session. The 79 is a return to the OR in the post operative period for unrelated procedure. The 50 modifier or two lines with RT then LT is correct.
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Would be very curious to know if it was a return or if they really did do both eyes in one session. Seems odd that a patient would be discharged from surgery with both eyes patched. After care (drops, etc) would seem difficult for a patient with no vision.

I wonder if the procedure was done while the patient was hospitalized?
 
Bilateral Cataract Surgery

There a few instances where a bilateral cataract surgery may be necessary (I can only think of the patient required general anesthesia off the top of my head). That being said you will post the surgery 66984 with the -50 modifier and accept the multiple surgery reduction 50% hit on the second eye. Don't bill with -RT(right) and -LT(left) modifiers and add a -59 modifier on the second eye, that's begging for an audit and unbundling. Don't bill two lines and put a -79 modifier on the second eye, that will cause problems for the doctor and the facility and the insurance is going to want to know why the doctor decided to return to the operating room after the first eye was completed.(and op note wont match your -79 modifier) Also check the documentation for the visit where surgery was decided and hope the doctor mentioned the need or rational for a bilateral cataract surgery.

Hope this helps

John D. Uecke COE, CPC, CPB, CPMA, CPPM, CMCO, CMIS, CMOM, CHA, MCMC, CHBS, OCS, CMRS, CPSS
President
NOVA Medical Billing, Inc.
 
No patch

briansmith99, just an FYI. Very few patients are patched after cataract surgery these days other than to wear a protective shield while sleeping the first few nights after surgery. Patching actually puts them at a higher risk for post op infection.

Tom Cheezum, O.D., CPC
 
This truly depends on your payer guidelines. I would start there, because for me, I have some that make us do things that make absolutely no sense.
 
Hello everyone, I am so sorry , for some reason i didnt get notification that you have replied.
Insurance is Medicare. I billed RT and LT they did not pay
I billed with mod 50 not getting paid either :/
I am trying with 79 and i will keep you guys updated.
 
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