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  • Surgical Complications, Part Two: Test Your Knowledge

    By Sue Vicchrilli, COT, OCS, Academy Coding Executive, and John M. Haley, MD, Member of the Academy Health Policy Committee
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    This article is from September 2011 and may contain outdated material.

    When a complication arises during surgery or during the procedure’s global period, how do you code for any additional surgical intervention that might be required before the end of the postop period? You will need to use modifiers –58, –78 or –79.

    Pop Quiz

    1. Following DSAEK in the left eye, the patient experiences graft dislocation that is repaired with an air injection in the office. What modifier(s) should you append to code 66020 Injection, anterior chamber of eye (separate procedure); air or liquid?
    2. The physician attempted to dilate and/or irrigate the lacrimal puncta of both lower lids, but there was no resolution of the patient’s condition. Eight days later, the physician probes and irrigates the nasolacrimal duct. The relevant CPT code is 68810. What modifier(s) should you use?
    3. Ten days after cataract surgery in the right eye, you discover that the patient’s refractive error is not what you had planned. The new glasses prescription required for correction would not be tolerated well by the patient. What modifier(s) should you append to CPT code 66986 Exchange of IOL?
    4. A patient with retinal detachment in the left eye underwent photocoagulation (CPT code 67105) and then, during the first procedure’s global period, has a scleral buckling procedure (CPT code 67107). What modifier(s) should you append to 67107?
    5. A patient who underwent bilateral blepharoptosis repair developed a lesion of the right eyelid during the global period. The lesion is red and painful and looks suspicious. The surgeon excises the lesion in the office. What is the correct modifier to append to CPT code 67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure?
    6. A patient received focal laser treatment for diabetic macular edema. During the postop period, the physician performs an intravitreal injection in the left eye. What modifier should be appended to CPT code 67028 Intravitreal injection of a pharmacologic agent (separate procedure)? 
    7. Cataract surgery was performed in the patient’s right eye. During the procedure’s global period, the surgeon repositions the IOL with a McCannel suture. The two codes involved are 66825 Repositioning of an IOL and 66682 Suture of iris (e.g., McCannel suture). CPT code 66682 is bundled with 66825. How would you code for this?

    Answers

    1. Whether the patient was treated in the office or ASC, you should use 66020–78–LT. Payment is 80 percent of $162 if the procedure is performed in the office; 80 percent of $116 in the ASC. (See “Part One” for the payment breakdown when –78 is used.)
    2. Use 68810–58. Typical allowable is $216 in the office; $174 in the ASC.
    3. Use 66986–78–RT. Payment is going to be 80 percent of $832.
    4. Use 67107–58–LT. Modifier –58 applies because the scleral buckling procedure is more extensive than the original procedure (see “Part One” for the three situations where you can use –58). This “lesser to greater” situation is the most common reason –58 is used. The typical allowable is $1,197.
    5. Use 67840–79. The typical allowable is $265 if performed in the office; $155 in the ASC.
    6. Use 67028–58. Payment is approximately $129 in the office; $108 in the ASC.
    7. Use 66825–78–RT. Payment is 80 percent of $684. What if you billed both codes? Because they are bundled by a CCI edit, you would only be paid for the McCannel suture—80 percent of $579—and would miss out on $84 of revenue.