Advanced Search

Ophthalmology and Optometry Coding Alert

Reader Question:

Cataract Extraction and Pterygium

Published on Mon Jul 01, 2002

Question: We performed a cataract extraction and a pterygium in the same session and billed Medicare, but the pterygium excision was denied because "payment is included in the basic/service or procedure." These are two separate procedures. How should we have billed these procedures? New Jersey Subscriber Answer: This was a payment error. The pterygium excision (65420, Excision or transposition of pterygium; without graft) should not have been denied. A pterygium excision typically is not part of a cataract extraction. You should send the claim back for review by the payer.

Make sure you attached modifier -51 (Multiple procedures) to the pterygium excision. Also, you should link the pterygium diagnosis (372.4x) for the excision and the cataract diagnosis (366.xx) for the cataract surgery. Answers to You Be the Coder and Reader Questions were provided by Lise Roberts, vice president of Health Care Compliance Strategies in Jericho, N.Y.; and Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All