Medicare Compliance & Reimbursement

Surgery on both eyes on different dates means 2 global periods. It's not always easy to keep your eye on accurate cataract coding, but today we've got a primer that can keep your eye surgery dollars coming in. With several possible cataract surgery treatments available to physicians these days, you'll face a lot of room for coding error -- which can equateto more than $600 at stake for cataract procedures in 2008. Use these tricky scenarios as a guide through some of the most problematic cataract coding situations that you might face. Append 79 for Surgery in Fellow Eye Scenario 1: On Feb. 1, a physician performs an extracapsular cataract removal with IOL insertion on a patient's right eye. One month later, on March 1, he performs the same surgery on the patient's left eye. Problem: The cataract procedure, 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]), has a 90-day global period, says Kimberly A. Lewis, CPC, OCS, coder for the Duke University Health System in Durham, NC. To report 66984 performed on the left eye a month after the original surgery, you'll need a modifier -- but which one? Solution: Because the two surgeries seem related, you may be tempted to append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to the second cataract surgery, but that would be a mistake. The surgery in the left eye is unrelated to the initial surgery in the right eye. The best option here would be modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), Lewis says. Remember also to append the "side" modifiers, LT (Left side) or RT (Right side), to demonstrate that the physician performed the procedures on opposite eyes. Report 66984-RT for the first surgery and 66984-79-LT for the second cataract surgery, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. Reimbursement for 66984 would be about $661.95, based on 17.38 relative value units (RVUs) multiplied by the 38.0870 conversion factor. Scenario 2: On May 10, the patient in Scenario 1 presents with after-cataracts in his left eye. The physician incises the posterior capsule with a YAG laser. Problem: The global period for the original cataract surgery expired before May 10. Do you need to append a modifier to the YAG capsulotomy? If so, which one? Solution: In this case, the global period for 66984-RT is over -- but the patient is still in the postoperative period for 66984-LT. When the physician performed 66984 on the [...]