Ophthalmology and Optometry Coding Alert

Question: A patient returns during the 90-day postoperative period of a focal laser for a repeat laser due to the eye still bleeding. Should I use modifier 58 or 78 on 67210? Pennsylvania Subscriber Answer: You should not use 67210 (Destruction of localized lesion of retina [e.g., macular edema, tumors], 1 or more sessions; photocoagulation) again during the same 90-day period, even with modifier 58 (Staged or related procedure or service by the same physician during the  postoperative period) or modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). The code's descriptor specifies, "one or more sessions" plural. The AMA considers the code for retina lasers to be a repeat service, or a series treatment. The Medicare Physician Fee Schedule assigns the code a 90-day global period so all repeat treatments during that period are included [...]