Tip: Your follow-up service begins the day after the ophthalmic surgeon relinquishes care|
Postoperative management of cataract surgery patients is a major component of a typical optometrist's practice--and, unfortunately, a major headache for optometry billers and coders. The right modifiers, as well as communication with the surgeon's office, go a long way toward clearing up cataract care confusion.
Experts attribute problems reporting cataract care to a misunderstanding of the rules governing postoperative care during the 90-day global surgical period--especially when the surgeon operates on the second eye within the global period of the first eye.
Scenario: An optometrist refers a 68-year-old Medicare patient with nuclear cataracts (366.16, Nuclear sclerosis) to an ophthalmic surgeon for cataract surgery on her left eye. On April 14, she has the surgery on her left eye. One week later, on April 21, she has cataract surgery on her right eye. On April 22, the ophthalmic surgeon relinquishes care, sending the patient back to the optometrist for the balance of postoperative care on both eyes.
Problem: How does the optometrist code for the follow-up care for both eyes?
Optometrist's Service Begins When Surgeon Relinquishes Care
By the time the optometrist sees the patient, he will be providing a different number of days of postoperative care for each eye. Cataract surgeries, whether reported with 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique, complex, requiring devices or techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage), 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]) or 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique), have a 90-day global surgical period in which postoperative care may occur.
When an optometrist assumes postoperative care of a cataract patient, his days of service begin the day after the ophthalmic surgeon relinquishes care, says Kennard Singh, CPC, CCS-P, CHCO, clinical administrator at SUNY State College of Optometry in New York City. In this scenario, the surgery on the left eye occurred on April 14. The ophthalmic surgeon relinquished care on April 22. Thus, for the left eye, the surgeon reports the surgery itself, as well as eight days of postoperative care. The optometrist provides 82 days of care. The postoperative period for the left eye is April 23-July 13, inclusive.
The surgery on the right eye occurred on April 21, the day before the surgeon relinquished care. For the right eye, the surgeon again reports the surgery, but this time only bills for one day of postoperative care. The optometrist provides 89 days of care for the right eye. The postoperative period for the right eye is April 23-July 20, inclusive………
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