Wiki Coding for Vitrectomy and Cataract in the same setting

[TiffanyM101]

If I'm billing Medicare, How would I code these 2 services for coverage? The DX code for the cataract SX (66984) is H25.811 and for the Vit (67042) I have DX code H35.371.
Medicare denied me on this claim, I was wondering if I needed to add a modifier 51 to get paid for these services that were done on the same DOS.

 

[thomas7331]

Medicare follows an NCCI guideline for vitrectomies that states "If an iridectomy or vitrectomy that is separate and distinct from the cataract extraction is performed for an unrelated reason at the same patient encounter, the iridectomy and/or vitrectomy may be reported separately with an NCCI-associated modifier. The medical record must document the distinct medical necessity for each procedure" (NCCI Policy Manual for Medicare Services, Chapter 8). So if your medical record meets this requirement, then it would be appropriate to report the vitrectomy with a modifier 59 or XU. If it is just done as an integral part of the cataract procedure, then the vitrectomy should not be separately reported.