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MODIFIER FOR COMPLICATION FROM 1ST SURGERY

Daniel y Posted Wed 09th of October, 2013 12:53:42 PM

From corneal tissue transplant complication, patient previously had, I need to bill 66020. Can I use modifier 79 or do I need to use modifier 78 and get reimburstment? Or is there any other modifier I can use?

SuperCoder Answered Wed 09th of October, 2013 17:15:12 PM

If the injection, for some reason, were performed in an ASC, the ophthalmologist might bill for it with 66020 (Injection, anterior chamber of eye [separate procedure]; air or liquid) with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). (Use 66020 instead of 66030 [ medication] because viscoelastic is a filler, not a medication.) However, the injection procedure requires no draping, prepping or anesthesia, so it is unlikely that it would be medically necessary to perform in an OR. If the viscoelastic agent is not stocked in the office, the physician might take the patient to an ASC or hospital outpatient OR for the procedure.
For private payers, if the ophthalmologist performs the procedure in the office, he or she would be able to report 66020–78 because not all insurers follow the same global surgery package guidelines as Medicare.

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