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Coding Retinal Repairs

Tammy Posted Sun 02nd of November, 2014 23:11:11 PM

Can you bill out the 67145 twice for the same eye during the same encounter if ones for a hole, and the other is for a retinal tear?

SuperCoder Answered Mon 03rd of November, 2014 02:50:47 AM

It would not be appropriate to bill 67145 twice for same eye during the same encounter if ones for a hole, and the other is for a retinal tear.

The procedure codes states one or more sessions.The subsequent treatment will be included in global for same eye.

Thanks !!

Tammy Posted Mon 03rd of November, 2014 12:39:16 PM

Would a modifier 22 be appropiate in this scenario?

SuperCoder Answered Tue 04th of November, 2014 03:01:39 AM

No, you can't use modifier 22. Code itself states one or more sessions. Modifier 22 will not be justified. Thanks !!

Tammy Posted Tue 04th of November, 2014 11:32:45 AM

Ok, so if the provider wants to bill it out again for the same eye the very next day, and claims its unrelated to the first visit can I bill it out with the modifier 79.

SuperCoder Answered Wed 05th of November, 2014 08:16:04 AM

Thank you for your question. Please see the criteria below for modifier 79. Supporting documentation would need to be submitted to show that the 67145 on the next day was completely separate and unrelated to the procedure done on the previous day.

67145 states: Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc)

Because it is one or more sessions, the provider would need to show that the procedures were unrelated.

Modifier 79 Fact Sheet

Unrelated procedure by the same physician during the post-operative period

Appropriate Usage

-To describe an unrelated procedure performed during the post-operative period of the original procedure.
-The two procedures are performed by the same physician
-All procedure codes except those with XXX in the GLOB (global) field of the MPFSDB.
-Used on services during the post-operative period starting the day after the procedure

Inappropriate Usage

-The procedure performed is related to the original procedure or a staged procedure.
-If the services performed are related to the original procedure, it is considered part of the global period.

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