Coding Q & A
Sharing Surgical Care With Non-retinal Physicians: Part 2
INFORMATION PROVIDED BY RIVA LEE ASBELL
In Part 1 last month, we reviewed surgeons of different subspecialties participating in a given operation and how to use modifiers 58, 78, and 79 when coding for surgery performed in the global period of another surgical procedure. In Part 2, we review some challenging case studies.
Q. The patient was struck in the eye by a broken blade from a remote-controlled toy helicopter and sustained a ruptured globe. The lens and iris were missing. The anterior segment surgeon also noticed a retinal detachment, which our retina doctor repaired using a scleral buckle. It is the same operative session but they did not assist one another. We cannot use Modifier 80. Is Modifier 62 even appropriate here?
A. This type of situation is frequently encountered in academic and large practices where the availability of different subspecialists is not a constraining factor.
Modifier 62 is not the answer in this case. Modifier 62 is used only when two surgeons are working together as “primary surgeons performing distinct part(s) of a procedure.” Each surgeon should then “report his or her distinct operative work by adding the modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code.”
This case neither fits the description of the modifier nor does it offer adequate reimbursement since the procedures are grouped together, paid at 125% of the allowable, and each surgeon is allowed 62.5% of the total allowance. Place modifier 79 on all of the retinal surgeon’s procedures.
TIP: Modifier 62 is best used in a situation where two surgeons of the same specialty and the same subspecialty operate together and more or less share the case.
FOUR-STEP COMPLEX REPAIR
Q. The anterior segment surgeon dropped the crystalline lens into the vitreous during cataract surgery and referred the patient to me. I first examined the patient two days later. The patient was aphakic. The surgeon had also attempted to suture a PC IOL, but it fell into the posterior segment. I performed a pars plana vitrectomy, a pars plana lensectomy using the fragmatome, retrieved the PC IOL from the posterior segment and placed an AC IOL through a limbal incision. How do I code this case?
A. Regarding the global period, no modifiers are necessary since the patient was from a different practice. However, you have some unusual coding issues of your own.
The CPT codes would be as follows: 67036 + 67121-59 + 66850 + 66985-59. These codes are: pars plana vitrectomy; removal of implanted material posterior segment, intraocular; lensectomy using phacoemulsification; and insertion of secondary IOL. These codes were chosen even though modifier 59 has to be used to break the National Correct Coding Initiative Bundles. I try to avoid this when possible, but it is the most accurate way of coding this case and reflects the original condition for which CPT code 67121 was developed.
Note that CPT code 66850 (anterior approach) is used and not CPT 66852 (pars plana approach) even if a pars plana approach had been used. CPT instructions specifically state to use code 66850 for associated lensectomy procedures with pars plana vitrectomy. This was also not an ordinary IOL exchange, such as that an anterior segment surgeon would perform.
TIP: Coding must be tailored to the circumstances, including whether an IOL was exchanged or retrieved or used secondarily. Other procedures commonly billable might include repositioning of an IOL and suturing of an IOL. RP
CPT codes copyrighted 2013 by the American Medical Association.
Riva Lee Asbell can be contacted at www.rivaleeasbell.com, where the order form for her new book, Tips on Ophthalmic Surgical Coding by Subspecialty, can be found and downloaded under Products/Books.
Retinal Physician, Volume: 10 , Issue: July 2013, page(s): 14