Wiki Issues in the Cataract Global Period

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bobsgirl

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I know issues related to cataract surgery are included in the global period. But what if the patient develops punctate keratitis or dryness related to the drops, develops a steroid response elevation in eye pressure, or something that is obviously linked like cystoid macular edema? Can this be coded separately or would it be included as well?

Thanks for your help.
 
The way I always think of it is: "Would this pt have this problem if they had not had cataract surgery?"

In your example of a steroid response or reaction to the drops, the answer would be no.

So I would code a post op visit as opposed to billing for it. Now, if the problem extends past the global period, I absolutely would start billing for it.

Hope that helps!
 
I disagree with the previous response.

Dry eyes or keratitis is separately identifiable from the cataract surgery. That is not a post op complication.

This would be a separately identifiable E/M billed with a modifier 24 if its within the global period.
 
Having comanaged several hundred post op patients, I would say that the answer regarding the punctate keratitis/dry eye "depends."

If the patient had dry eye before the cataract surgery and it got worse as a result of the side effects from frequent use of the post op drops, then I would say you could bill for the visits to resolve the dry eye issues during the global period.

Most cataract surgeons will evaluate for dry eye during the pre op exam.

If there was no preexisting dry eye and the patient develops the punctate keratitis as a result of using the post op drop, and I've seen many that this happens with depending on the drops used, then I would say that should be dealt with under the global fee of the post op period. If it continues past the 90 global period, then you could start billing for those visits.

Tom Cheezum, O.D., CPC-A
 
Icd-10 opthalmology post-op global charges

I have a question about ophthalmology ICD-10 coding. When the patient has the YAG laser procedure for cataract removal; he/she then sees the ophthalmologist in the office for the post op visit. The physician is asking for the ICD-10 post-op code, during the global period. This is a straight forward post-op visit without any complications. I am not able to locate any ICD-10 codes, except the Z98.4 category for cataract extract status. The Dx would be H26.499.

I would appreciate any insight on finding the correct post-op code to charge during the global for when the patient is seen without any complications. I would also appreciate it very much if you could point me to the website or any literature to back up the answer so I can have it for educational purposes for my providers.

Thank you in advance for your help.

Donna, CPC, AAS
 
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