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Coding, modifiers

Alea Posted Fri 17th of February, 2017 11:11:40 AM
Planned 65755 was performed and during the procedure it was evident that the IOL haptic had broken and the IOL was dislocated and a piece of the haptic had fallen onto the retina. So he ended up performing: 65755 & 66986. What is the proper way to bill this? Thank you
SuperCoder Answered Mon 20th of February, 2017 04:26:51 AM

This is a case of discontinue of procedure because of patient’s condition. So, append modifier 53 with the procedure code you performed. Modifier 53 is to append with a diagnostic or surgical procedure when the physician begins a procedure and then decides to terminate it, since continuing the procedure will threaten the patient’s health. The provider’s documentation should explain why he discontinued the procedure. Submit the documentation with the insurance claim to justify using modifier 53.

Alea Posted Mon 20th of February, 2017 13:49:16 PM
He did not discontinue the procedure. He did the planned procedure and fixed both problems that he found once he got in there. As I said before he ended up performing both: 65755 & 66986 What is the appropriate way to code this?
SuperCoder Answered Tue 21st of February, 2017 06:06:13 AM

In CPT code 65755, penetration refers to the thickness of the donor cornea, indicating its full thickness. The physician measures the patient's cornea to select the size of trephine that will be used to excise corneal tissue. The physician punches a circular hole in the cornea of the donor eye using the trephine. The physician removes the disc of corneal tissue, threads it with preplaced sutures, and sets it aside. A metal ring may be sutured to the sclera of the patient to stabilize the operative field. The defective cornea of the patient is removed with the trephine. The donor cornea is positioned with sutures; additional sutures secure it to the cornea. The physician may use a saline or air injection to restore proper intraocular pressure. Code 65755 is for patients who have an artificial lens or are pseudophakic-without natural lens. Whereas, in CPT code 66986- is for exchange of intraocular lens in which the physician exchanges the problematic lens for a newer one. For anterior IOL, the physician replaces an intraocular lens in the fluid-filled space between the iris and cornea (the anterior chamber). The optic, or center, of the implant lies just in front of the pupil and the haptics (securing attachments) of the implant are lodged between the iris and cornea, fixating the implant so it cannot move. For posterior IOL, the physician injects a bubble of air into the anterior chamber through a syringe to protect the cornea. The physician replaces the intraocular implant in the eye. The haptics lodge into the ciliary sulcus or the lens capsule. According to your description of the procedure performed, you can bill both the procedure together. Also can add the modifier 22 for excessive work you have performed except the two procedures you will be billing i.e. CPT 65755 and 66986. Check your documentation and append the modifier only when can support the increased procedural services. In order to append modifier 22 to the procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

• Increased intensity

• Additional time

• Technical difficulty

• Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician.

NOTE- An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult.

Alea Posted Wed 22nd of February, 2017 10:51:49 AM
Thank you
SuperCoder Answered Thu 23rd of February, 2017 00:25:09 AM

You are welcome.

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