Hilde Posted Tue 19th of February, 2013 19:47:03 PM
We had a patient who had cataract removal. Surgeon ended up having to do an anterior vitrectomy and inserting an a-c IOL. During post op, physician needed to do a laser iridotomy as prophylactic against pupillary block. This was done in a dedicated laser suite. I am not sure what diagnosis code to use - any thoughts?
SuperCoder Answered Wed 20th of February, 2013 10:40:34 AM
You can bill 66761 with mod. 79 to sjow that the surgery is being done within global period of another surgery, within an OR set-up, which the "laser suite" is.
An “operating room” is defined as a place of service specifically equipped and staffed for the sole purpose
of performing surgical procedures. The term included a cardiac catherization suite, a laser suite, and an
endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an
intensive care unit unless the patient’s condition was so critical there would be insufficient time for
transportation to an operating room.
If billed without modifiers like 58, 78 or 79, Medicare and many other payers will deny the service. MCR Claims Processing Manual states:
The Medicare Claims Processing Manual, further states:
“Do not allow separate payment for an additional procedure(s) with a global surgery fee period if
furnished during the postoperative period of a prior procedure and if billed without modifier “-58,” “-78” or
“-79.” These services should be denied.” (CMS Publication 100-04, Chapter 12, Section 40.4A).
Dx codes: V58.71, V45.61, V43.1