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  • Insurance company taking back payment for 66984 when cataract and retina surgery performed on the same day by two different surgeons.

    I have a question regarding same day cataract and retina surgery by two different surgeons. Our patient undergoes cataract surgery 66984 by Dr. ABC. The same day, in a separate operatory room, Dr. XYZ performs a complex retinal detachment repair 67113. This is not performed as a complication of surgery. We bill 66984 (Diagnosis H25.12) for Dr. ABC. We then bill the encounter for 67113 (Diagnosis E11.3532) by Dr. XYZ using a 58 modifier. Both are paid, however the payment for 66984 is now being taken back by the insurance company. 

    CPT codes 67113 and 66984 are bundled. When performed the same day, -58 modifier is not correct. If the same group practice, the bundle would apply.  Because separate surgical sessions, separate structure, it would be appropriate to unbundle with -59 modifier.