Ophthalmology and Optometry Coding Alert

" The eye modifiers (-LT, Left side; and -RT, Right side) can be the key to ensuring proper reimbursement, especially when similar procedures are performed on both eyes. For example, if you perform a procedure on one eye within the global period of the same procedure on the other eye with the same diagnosis, the eye modifier clearly shows why Medicare should reimburse you for the second procedure with no fee reduction.

Without the eye modifiers, the payer will assume the procedure except for lasers, which are discussed below is performed to treat a complication and will reduce the fee by the amount of the postoperative component of the global surgery package (usually 20 percent). If the second procedure is performed on the other eye, it is by definition unrelated, says Raequell Duran, president of Practice Solutions, a Santa Barbara, Calif.-based coding and reimbursement consultancy. You should also append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the second procedure, which indicates that the procedure is unrelated to the one that initiated the postoperative period. Note: Append modifier -79 before the eye modifier because modifier -79 is the payment modifier. Payment modifiers explain why your claim should be paid outside the global surgical package. The -RT, -LT, -E1 (Upper left, eyelid), -E2 (Lower left, eyelid), -E3 (Upper right, eyelid) and -E4 (Lower right, eyelid) location modifiers are informational modifiers and should always be listed after any payment modifiers. In addition, you should also have attached modifier -LT or -RT to the procedure code for the original surgery. Otherwise, the modifier on the subsequent procedure code would be meaningless. Because the eye modifiers are informational modifiers, they do not reduce or alter your fee. Using Modifiers With Lasers With all laser procedures described as including one or more sessions or stages, you should use the eye modifiers even if you do not anticipate performing the procedure on the other eye. You can only bill one laser procedure of the same code in a 90-day period on the same eye because these codes are defined as for one or more treatments. Laser codes are always unilateral.

Relevant laser codes include the following:   65855 Trabeculoplasty by laser surgery, one or more sessions (defined treatment series) 66761 Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) (one or more sessions) 66762 Iridoplasty by photocoagulation (one or more sessions) (e.g., for improvement of vision, for widening of anterior chamber angle) 66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife) 67105 Repair of retinal detachment, one or more sessions; photocoagulation, with [...]