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Wiki Cataract Surgery - f/u visits

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kst3501

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A individual has the cataract surgery done at a VA hospital but wants to do the post surgery visits with a local opthomologist - Can anyone share the right process to code the follow up visits - modifier along what documentation is requred from the patient to transfer this service. Thanks
 
Ideally, the VA should append modifier 54 to the surgical code to indicate pre-op and surgical care, then the local ophthalmologist submits one bill with the cataract surgical code, and modifier 55. The insurance carrier should split the payment between the providers, paying the appropriate portion based on the services provided. The documentation should include the date of surgery, provider, location, and indicate that the patient has elected to received post-op care from a separate provider.

Our practice has successfully used this when the patient relocates either to or from a different area.

Hope this helps!

Nancy Machado, CPC, CEMC
 
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