Multiple physician surgical coding question

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7
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Saginaw, MI
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Hello,

I have a case that I need a little help on. A patient came in for an IOL removal cpt 66852 with diagnosis T85.79XA that was to be completed by one of our physicians (lets call them Dr. A) followed by a anterior vitrectomy with a second physician (lets call them Dr. B) that was in the O.R. thru the duration of the case. Dr. A failed to extract the lens (66852) the surgery was then taken over by Dr. B who removed the lens and preformed the anterior vitrectomy.

We are an Ambulatory Surgical Center.

Here is how I think we should bill this but I am not sure if it would be correct.
Dr. A 66852-74
Dr. B 66852-77 and 67010

Any input would be helpful. Also the girls who code for the physician portion are stuck as well so any help would be great. Thanks.
 

thomas7331

True Blue
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My initial thought, based on the information you've given, is that as a facility you would not want to bill the code twice since this was a single operative session. Since you're billing for facility resources, not physician, to bill it this way suggests that the initial procedure was discontinued and the patient left the operating room but was brought back in later for a repeat procedure. From the viewpoint of facility resources, the initial procedure was not really discontinued, assuming the patient did not have to be prepped again or put back under anesthesia, it was just that the procedure was taken over by a different provider during the session. But if the documentation supports that significant time and/or facility resources were used due to the complication that required 2 physicians, then you could argue to support it.

As for the physician coding, we'd need to know first if the providers were of the same or different specialties or subspecialties and/or practices. If they're the same, then payers will look at them as a single physician and wouldn't likely allow the code twice for the same site and same operative session. If they're different, and if there is supporting documentation as to the medical necessity of a second provider having to repeat the procedure, it might be warranted to bill the discontinued procedure with modifier 53 and bill the full procedure separately under the second provider. You'd need to look closely at the circumstances to really be able to decide how to proceed on this though.
 
Messages
7
Location
Saginaw, MI
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0
thomas7331 Thank you

Thank you Thomas. I agree totally with what you are saying. As for the physician portion one specializes in retinal disorders and the other cataract and corneal issues. So it seems like they probably should just bill for one of them. Thanks for all of your help.
 
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