JAN 23, 2018
Billing Patients for Repeat Surgeries in Global Period
Revised June 2018
Question: The doctor performs a surgery in which the CPT language states “one or more sessions.” The procedure must be repeated during the 90-day global period. Is it possible to have the patient pay for the second procedure after signing an Advance Beneficiary Notice (ABN)?
Answer: No. The second surgery is part of the global period and should not be billed again to the payer or the patient.
CPT codes that have 1 or more sessions in their CPT descriptor are:
- 66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma)(per session);
- 66762 Iridoplasty by photocoagulation (1 or more sessions);
- 66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages);
- 66840 Removal of lens material; aspiration technique, 1 or more stages;
- 67031 Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages);
- 67141 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; cryotherapy, diathermy;
- 67145 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; photocoagulation (laser or xenon arc);
- 67208 Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; cryotherapy, diathermy;
- 67210 Destruction of localized lesion of retina (eg, macular edema, tumors) 1 or more sessions; photocoagulation;
- 67218 Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; radiation by implantation of source (includes removal of source);
- 67220 Destruction of localizes lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), 1 or more sessions;
- 67229 Treatment of extensive or progressive retinopathy, one or more sessions; preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy
Under no circumstance should you charge the patient as described. Medicare might interpret this as an attempt to commit fraud and inappropriate use of an ABN. Medicare Part B pays for the entire 90 days, no matter how many additional times the physician must repeat the surgery.
Learn more about the ABN in Ophthalmic Coding: Learn to Code Essentials.