Today, I came across a scenario where three modifiers are used together which is very rare. So, I would like to share that scenario which will surely help to use the modifier wisely. Below is the question with the answer as well.
Question :An ophthalmologist performs cataract surgery on a patient’s right eye two weeks after performing cataract surgery on the patient’s left eye. The patient has an age-related nuclear cataract. The patient tolerates the procedure well and remains under the surgeon’s care for eight days after the procedure and then returns to their optometrist for a post-op visit. How is the ophthalmologist’s service coded?
CPT codes and ICD 10 codes are;
The rationale for the answer is given below.
CPT code 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation is assigned since the procedure was not complex.
Modifier 79 Unrelated procedure is required, as the question specifies that this procedure is taking place two weeks after the previous surgery, which means the patient is still within their 90-day global period. This indicates to the payer that the procedure is unrelated to the first surgery.
The first code is submitted with modifier 54 Surgical care only so the surgeon will be reimbursed for performing the procedure itself. The second code is submitted with modifier 55 Postoperative management only because the surgeon only followed the patient for eight days of the global period. The surgery was performed on the right eye (modifier RT), so the best ICD-10-CM code is H25.11 Age-related nuclear cataract, right eye.
Hope the above scenario will help you clear your doubts on using multiple modifiers with CPT code.
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