Wiki Cataract surgery post-op care only


Marshfield, WI
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When patients from our optometry practice are diagnosed with cataracts they are referred to a surgeon. Following surgery the patient returns to our optometry practice for postoperative management only. We see the patient anywhere from 1-3 weeks postop. The surgeon provides us with a transfer of care letter with the information that we need to bill. We bill the same cataract code as the surgeon, with a modifier -55. If the patient is having both eyes done, they will return again for postoperative management of the second eye. When the patient is seen for postop visits for the second eye, should I use modifier -55 as well as -79 because the patient is in a global period from the first surgery? Does our optometry office need to base our fee on the number of postop days that we are treating the patients? How do we know what 20% of the charge is? The surgeons do not share the fee with us. Thank you.
Cataract post op

For the second eye, you only use the 55 modifier. The surgery is done on a different eye so you are starting a new 90 day global period for that eye.
To find the fee, go to the website for your Medicare carrier for your area and they should have the fee schedule for the various CPT codes. Look up the CPT for the surgery and determine what 20% of that fee would be. For example 20% of a $500 fee would be $100.

You then have to figure out how many days of the 90 day period you are providing care for based upon when you first see the patient after the surgery. If you see the patient on day 1 after surgery, you would bill for the full 90 day global fee. If you start care at the end of week 1 after surgery, you would bill for 83/90 of the post op fee. Once you see the patient for the first visit, you are responsible for the balance of the 90 days of post op care and bill accordingly.

Tom Cheezum, O.D., CPC, COPC
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I believe both the 55 and 79 modifiers are necessary. The 79 modifier indicates that the service is unrelated to the global period of the first eye. I also append either the RT or LT modifier as well.

Teresa Troutman, CPC
When you use the 55 modifier, you also have to use either a RT or LT to go along with that. Using either of those would automatically show that it's not in the global period for the first eye and is, in fact, for a different part of the body. I believe that would exclude the need for the 79 modifier.

Tom Cheezum, O.D., CPC, COPC

If first eye was right it should be 55 RT, then left eye should be billed 79 55 LT. The surgeon should match this as it is correct because you are in the global period of the right eye, 79 is required. Next as to price and start date, you should base this off the surgeon's letter. Their letter should state whether they are billing post op care and what date you take over care. In our office we bill as of next day because our surgeon letter states they are not billing for any post op care, so we are responsible as of first day after surgery. In your additional information area of claim is where you clarify the time frame you have taken over post op care. So for my above example I would put
surgery 07/15/17 assumed care 07/16/17 to 10/14/17; 90 days. Now if the surgeon did not sign over post op care till after first week, you would change information in additional information. Surgery 07/15/17 assumed care 07/22/17 to 10/14/17; 84 days, insurance will pay less based on this. What we bill never changes but our reimbursement from insurance does based on the information put in additional information.