Ophthalmology and Optometry Coding Alert

Correctly applying modifier 78 to YAG capsulotomies could be worth $197Ophthalmologists 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 GlobalThe 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: Choose ICD-9 code 366.53 (After-cataract, obscuring vision).Treatment: To treat after-cataracts, ophthalmologists incise the posterior capsule with an yttrium aluminum garnet (YAG) laser, allowing the capsule to contract and stop obstructing the passage of light to the retina.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 [e.g., irrigation and aspiration or phacoemulsification]) --" have 90-day global surgical periods, says Kimberly A. Lewis, CPC, OCS, coder for the Duke University Health System in Durham, N.C. This makes coding YAG procedures for the majority of patients straightforward.Report 66821-RT or -LT (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]; Right side or ...Left side) 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.Document Necessity for OR ReturnsOphthalmologists sometimes treat after-cataracts within the global period of the initial cataract surgery. In these cases, 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 66821 (66821-78-RT or -78-LT) to break it from the 6698x global surgical packages.Heads up: In 2008, CPT revised the definition of modifier 78 to include the words "unplanned" and "procedure room," says Raequell Duran, CPC, president of Practice Solutions in California, who led the "Modifier Essentials" seminar at The Coding Institute's 2008 Ophthalmology Coding Conference. A laser suite in the [...]