Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: If laser suture lysis is performed in the office during the postoperative period on a patient after trabeculectomy, is there a way to bill for it with a certain code and modifier? Florida Subscriber

Answer: Trabeculectomy is the removal of part of the trabecular meshwork for treatment of glaucoma. Sometimes, the ophthalmologist places a suture with the intention of cutting it during the postoperative period if the flow of fluid out of the eye is too restricted by the sutures.

You may have heard that some coders bill for the removal of the sutures by using 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) with modifier 78 (Return to the operating room for a related procedure during the postoperative period). Even though some carriers may pay for this, it is not correct coding and should be discouraged.

Suture removal to affect the flow through the trabeculectomy should not be billed to Medicare because of Medicare's definition of the global surgical package. The Medicare Carriers Manual states that the global package includes miscellaneous services items such as dressing changes, local incisional care, removal of operative pack, removal of cutaneous sutures, lines, wires, tubes, drains, etc. For ophthalmology, this includes suture removal by any method. Therefore, you should not bill separately for suture removal by laser lysis.