Don’t Forget DOS on Your Post-Op Service Medicare Claims
Question: We have been billing for the co-management of cataract surgery post-op services, and every payer except Medicare reimburses the providers for the services. Depending on the eye treated, we’re reporting 66984-55 appended with either LT or RT. We assign 66984-54 for the surgeon who is co-managing the post-op services. How can we amend our claims for Medicare reimbursement? Georgia Subscriber Answer: Code 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation) is the correct code to assign in your situation. You’re also correctly appending modifier 55 (Postoperative management only) and RT (Right side) or LT (Left side) to report the post-op services for either the right or left eye. According to the Medicare Claims Processing Manual, chapter 12, section 40.2.B, you’ll need to also include the pre-op and post-op dates of service (DOS) for proper reimbursement of 66984-54 (Surgical care only). “Physicians who share postoperative management with another physician must submit additional information showing when they assumed and relinquished responsibility for the postoperative care. If the physician who performed the surgery relinquishes care at the time of discharge, he or she need only show the date of surgery when billing with modifier ‘-54,’” the manual states. Additionally, the physician who provides the rest of the post-op care needs to document the date that they assumed the post-op care by recording it in Item 19 on the CMS-1500 form. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
