Wiki 67113, 67228

[colleen.rettig@carle.com]

I have a doctor that is charging 67113 and 67228. These charges are bundled. His argument is he is fixing a retinal detachment, but doing photocoagulation on a separate part of the eye, away from the detachment. Can I add a mod 59 and send this thru? thanks!

 

[rizeninme]

Since 67228 is being done at the same time as 67113 on the same eye, my opinion is that it is not truly a "distinct procedural service" and -59 is not appropriate. Since the codes are bundled, what I would recommend is adding a -22 to 67228 and appeal with the op report for higher reimbursement on the basis that the service provided was greater than that usually required.