Coding Question

Good Morning! I wonder if anyone has run across this situation. We have a retina surgeon that performed a 67113 and a cataract surgeon that performed a 66982, same patient, same session. Medicare added a 51 modifier on the 66982 and is allowing half the billed amount. We billed a 66982-79 RT and a 67113 58, RT. Is there a different modifier we should have used? I know the codes are normally bundled but since there were different surgeons we thought should be allowed in full. Thank you for your help. Deedee Miller

re: coding question

Surgeons from same group? Unless they are of a medicare recognized different specialty, they are considered same provider....hence the multiple surg discount.

Coding Question

Yes the surgeons are from the same group. Sounds like we were paid appropriately then.

reimbursement

First and foremost, 67113 is not a code to be used simply because the case was difficult or you encountered complications. For the most part, it is used when the surgeon knows prospectively that the case is going to be complex. This is parallel to the use of the complex cataract extraction code.
The code descriptor in CPT® reads as follows:
"67113 Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens."
66982 is bundled into code 67113 with an indicator of “1”. When you have an indicator of “1” it means the 66982 can be billed if unrelated to original procedure (67113). Appears to be of same eye.
Appears, by your description, that Medicare is paying based on multiple procedure rules (modifier -51) (if you are getting 50% of 2nd procedure)-which means the physicians are from same practice. The secondary procedure (cataract) will be allowed 50%--the modifiers you used are not appropriate in this case.