Question Dual Surgeon Case Billing for 66991?

[christylynne78@gmail.com]

Hi!
I do the ASC billing for our facility and I have 2 surgeons who just performed a "combo case" and I'd like to make sure my thinking on coding of the case is correct. Procedure in question is 66991 - one physician performed the cataract sx piece and the 2nd physician performed the stent portion. Modifier 62 is not an option because the indicator is 0 and co-surgeon billing is not permitted. The Assistant Surgeon indicator is a 1, so I'm thinking modifier 80 - but the indicator also clearly states "Assistant at surgery may not be paid." The stent surgeon wants to bill 0671T and have the other surgeon bill 66984 - but I said that is not an option because 0671T is only for when there is no concurrent cataract surgery, and clearly here there is a cataract component.

Has anyone else come across this scenario? I'm typically not involved on the front end of scheduling cases, so I am kind of stuck with billing this case somehow at this point.

Thank you in advance!
Christy-Lynne Campbell, COC, CPC

 

[Cheezum51]

Just a question. Why would this require two surgeons? Was the second surgeon actually teaching the first surgeon how to do the MIGS part? If that was the case, then I wouldn't think the second surgeon is eligible for reimbursement. I believe your thoughts about "splitting" the procedure are correct. That, in my opinion, would be fraudulent if you billed the second surgeon with the 0671T just for them to get paid.. If the second surgeon is that concerned about being paid/given credit for the MIGS portion, perhaps for their income purposes, then perhaps the practice can give the first surgeon credit internally for the cataract surgery and the second credit for the difference in reimbursement for the MIGS portion.

Tom Cheezum, OD, CPC, COPC

 

[christylynne78@gmail.com]

Hi and thank you for the reply! I didn't get notification of a response to my question, so my apologies for the late response. The second surgeon performed the cataract portion of the 66991 due to a pre-existing cornea transplant (his taxonomy delineates him as a "Cornea and External Diseases Specialist." I do not have record of our cornea specialist being the surgeon responsible for the initial cornea transplant, so in my mind he would be the assistant surgeon on the case. Does that change the thinking at all? Thank you in advance!