Wiki 67973 and 67975

[tobeornottobeacoder]

I have a patient that had surgery on 4-8-13 for a reconstruction of the total eyelid, first stage (67973) and went back on 5-10-13 for the second stage (67975). According to my CPT modifier book from the AMA it states: If the description of the procedure indicates the procedure is staged, modifier 58 is not appended. Each stage is reported separately. The second surgery was denied by Medicare saying it was bundled with the surgery done on 4-8-13. Why?? The description on each one of these codes specifically says 1st stage and 2nd stage. Has anyone else had this issue with Medicare? Do I just append this with 58 and be done with it? I dont get it. You read all the information available to make sure you bill the claim correctly the first time and Medicare comes back and doesnt like it. Any advice on this would be helpful. Thanks so much.

 

[AllisonTanksley]

Eyes are not my coding specialty... however when I read the description Of CPT 67973 and 67975 and the description states "stage 1" or "stage 2", my thought would be that it is indicating that the reconstruction of the total eyelid can be done in up to two surgical encounters, whether within the 90 day global period of "stage 1" CPT 67973 or not.
In this case, since the reconstruction of the lower eyelid did take two surgical encounters and the second stage was within the 90 day global period of the first stage, then a -58 modifier would be apprpriate on the second stage CPT 67975.
I hope that is helpful.
Allison Tanksley, CPC