Ophthalmology and Optometry Coding Alert

Curious coding may kill your cataract reimbursement - documentation and modifiers will leave Medicare purring Ophthalmologists perform thousands of cataract surgeries each year, which can lead to a fair share of post-op complications that can be difficult to code. Fair reimbursement for postoperative procedures for complications - such as after-cataracts - depends on airtight documentation and skillful modifier use. Beware PCO Within Global The problem: Posterior capsule opacification (PCO), also known as an "after-cataract," is one of the most common problems following cataract surgery (a report from the Surgeon General found that 41 percent of patients develop PCO within 48 months after cataract surgery). In PCO, residual lens epithelial cells, left behind during the original surgery, proliferate and migrate. The membrane behind the new inserted intraocular lens thickens, blurring the vision.

Diagnosis: ICD-9 code 366.53 (After-cataract, obscuring vision)

Treatment: To treat after-cataracts, ophthalmologists incise the posterior capsule with a yttrium aluminum garnet (YAG) laser, allowing the capsule to contract and stop obstructing the passage of light to the retina.

"After-cataracts develop slowly, with most patients not noticing blurred vision right away, since they have experienced such improved vision from the cataract surgery," says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif. "Many patients will not mention a complaint of blurred or decreased vision until cataract surgery is performed on the fellow eye and they notice the distinct difference in the clarity of their vision."

Cataract surgery procedures - including 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique, complex, requiring devices or techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage), 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]) and 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique) - have 90-day global surgical periods, so coding YAG procedures for the majority of patients is straightforward, says Armeda Smith, CPC, senior coding specialist for the ophthalmology department of the University of Texas Medical Branch in Galveston. Report 66821 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]) and link it to 366.53. No modifiers are necessary if the YAG procedure takes place more than 90 days after the original cataract surgery and the patient is not within a post-operative period for any other surgical procedure performed by your physician or group, Smith says. Document Necessity for OR Returns Ophthalmologists sometimes treat after-cataracts within the global period of the initial cataract surgery. In these cases, append modifier -78 (Return to the operating room for a related procedure during the postoperative period) [...]