Root Love // Cyberpunk NIFO

When you code for cataract surgery in the postoperative period using the -LT and -RT modifiers, remember that the guidelines are somewhat different. Most carriers maintain that you cannot bill a visit within the cataract surgery postoperative period for the decision to perform a similar procedure on the other eye. The general claim is that you had already decided that the second eye should be treated when you decided to perform surgery on the first eye.

Many carriers consider cataract removal an elective procedure that can be performed at any time. That makes the condition different from an exacerbation of an underlying disease process that requires a non-elective procedure. Consequently, modifier -24 may not suffice when you seek reimbursement for an E/M visit performed within the cataract surgery’s global period.

While you may not be reimbursed for your E/M service, your carrier will pay for the cataract surgery, and you should use the eye modifier to do so. You should report the procedure with modifier -79 and the appropriate eye modifier if done within the global period of the first cataract surgery. If you billed for the first procedure with the appropriate eye modifier, you should receive the full Medicare fee schedule amount for the second procedure.

For instance, during the cataract surgery postoperative period for the left eye, the ophthalmologist notices that the right eye – which had cataract surgery with an intraocular lens (IOL) a year ago – has developed a significantly cloudy posterior capsule that requires surgery. When the procedure code for cataract -66821 is performed that day or the next day, you should report the office visit with modifiers -24 and -57. Append modifier -79 and modifier -RT to the surgical procedure code. Link the diagnosis code 366.53 to 66821-79-RT to show medical necessity for the procedure.

When you code for cataract, keep your notes clear and in long-hand whenever possible – words work best for auditors, and for your reimbursement too.