Wiki experienced eye coder help!

[rhotonscott]

A few questions:
1) Able to bill IOL Master interps 92136 left and right if Dr performs them at same visit for cataracts on both eyes, right? It saves the patient a visit-BUT per NCCI edits cannot bill IOL Master interp (92136-26) on one eye and IOL by immersion ultrasound interp (76519-26) on the other eye at same visit. Sometimes the patient has cataracts in both eyes, but one is dense cataract so he has to do ultrasound to get correct measurements. This seems odd to me...should I only be billing for the IOL calc on the eye being operated on at that time? What happens to the other interp?

2) Ophthalmologist performs CPT 67108 and introduces gas into the posterior segment to keep the retina flat. During the global, in clinic visit, the doctor goes in and removes the gas due to high IOP. He documents perfectly what he did and why. Is this removal inherent in the billed procedure?. From what I have been able to find there is a possibility I may be able to bill the removal of the gas, even during the global period, using a -58 modifier with the appropriate CPT code. Is this true? and if true, what is the procedure code for removing the gas tamponade(CPT 67121 gives 900$ per ingenix-looks too expensive for intravitreal aspiration only)

 

[dmcvinney]

1) In my experience, you can't unbundle 76519 and 92136, ever. Even if you bill one interp today in advance of the first surgery, and one next month in advance of the second surgery. We have tried doing this and couldn't get it paid even on appeal with our Medicare payor, even though different dates of service and different eye modifiers, and in theory bundling only applies to same date of service. In the case you mention, we would just bill 76519 for both eyes.
2) Does one of the indications for modifier 58 really apply in this case? (planned, more extensive or for therapy?). Although I don't know for sure, seems unlikely. More likely it would be a 78, and the procedure would only be covered if it required return to OR or designated procedure room. Seems 67121 would be the appropriate code if it was performed in a designated procedure room and not the lane. Otherwise included in the OV.