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Post-Op Billing

  1. #1
    Pearland, TX
    Question Post-Op Billing
    Medical Coding Books
    This is the first time our optometrist has seen a patient for post-op care for cataract surgery. I am not sure how we should bill this. Do we use a regular office visit code with a mod 55 or do we use the surigcal procedure code 66984 and mod 55? This is a non-medicare patient on a one day f/u visit. They are suppose to f/u in 1 week and then in 1 month from what I have been told.

    Any help would be greatly appreciated.

    Nancy Cooper, CPC

  2. #2
    I assume your office and the surgeon's office agreed to co-manage the surgery? If so, they need to provide you with the exact codes that they billed for the surgery, including diagnosis. They should have billed the surgery with a 54 modifier. You will bill the exact same codes except with a 55 modifier followed by RT or LT. Use the date of the surgery as your date of service. Enter the surgeon's name and ID number as the referring physician. Also, in box 19 enter the length of the post op care you are providing (normally 90 days) followed by the dates. There are online calculators where you can enter the date and it will tell you what date is 90 days later. You bill only one time for the post op period regardless of how many times you see the patient. The only exception is if you see them for something unrelated to the surgery during that period. You will have to determine what to enter as your billed amount. We bill $200. So, if the surgeon billed 66984 54 RT, you would bill 66984 55 RT using the same dates of service. If the surgery was done on today's date, 6/24/11, you would enter in box 19 90 Days 06-24-2011 to 09-22-2011. These are the instructions Medicare gave to me the first time I billed for co-management and I have billed other carriers in the same way. There is always one who wants something different, but this should work for most carriers.

  3. #3
    Pearland, TX
    Thanks! That is a big help.

    Nancy Cooper

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