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co-management of cataract surgery

Donna Posted Tue 31st of July, 2012 20:13:46 PM

We co-manage our cataract surgery with multiple locaL ODs. One of them does all the post op care. Do I still have to bill the
66984-55 for one day post-op, even when the other Doctor sees the patient starting the day after surgery?

SuperCoder Answered Wed 01st of August, 2012 14:06:23 PM

An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?

Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 with modifier 55 (Postoperative management only) appended for 90 days of service. If the surgeon turns over care to the optometrist immediately, the optometrist is responsible for postoperative management for the whole 90 days, regardless of when he first sees the patient.

Split care: If the ophthalmic surgeon does not transfer care immediately, he may report 66984-55 for however many days he remains responsible for postoperative management. The optometrist then reports 66984-55 for however many days remain in the 90-day global period. The ophthalmic surgeon should append modifier 54 (Surgical care only) to the cataract surgery code (for example, 66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Example …

The patient has cataract surgery on the right eye on March 7. The 90-day global period for this surgery ends on June 5. The ophthalmic surgeon relinquished care on March 14. The optometrist first sees the patient on March 17. The optometrist’s postoperative care begins on March 15, even though he does not see the patient until March 17.

Because the surgeon did not relinquish care until the postoperative period was already in progress, he should code for seven days of postoperative care (March 8-14).This leaves 83 days of postoperative care for the optometrist to report — March 15 through June 5.

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