Optometrist's Guide to Billing Cataract Post-Op Care
optometrist's guide to billing cataract post-op 3:32 PMWith cataract surgery the most commonly performed surgical procedure in the United States (an estimated 3.5 million surgeries are done each year by ophthalmologists in the US!), optometrists take on the majority of post-operative care needs for these patients. Typically the ophthalmologist who performed surgery sees the patient for a 1 day post-op visit, and then releases care to a partnering optometrist for the 1 week and subsequent follow-up visits over the 90 day post-operative period. Optometrists are trained and skilled at handling post-operative care and complications, but handling the billing and coding for post-operative care poses unique challenges because insurances require that the doctor split reimbursements with the surgeon who performs the surgery and who who initiates the post-op care on day 1. If you need a quick reference on filling out insurance claims for post-operative cataract surgery care, this guide is for you!
When you see the patient for their initial post-op visit under your care, you will file CPT code 66984-EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS
- Link this code to the cataract in the eye that just had surgery. Yes, I know there is no cataract now during your post-op care because surgery was done to remove it. But your post-op care is getting partial payment from insurance for the overall procedure, so you're linking it to the cataract that used to be there. It is important that you use the same cataract code that the operating surgeon did. If the codes don't match, insurance will reject. Most surgeons use H25.81X Combined Forms of Age-Related Cataract, but make sure you match what was used in the transfer of care document sent by the surgeon.
- use modifier -55 Post-Operative Management
- use modifier -LT or -RT pending which eye was operated on (and make sure you've linked that to the appropriate cataract code H25.811 for right eye, H25.812 for left eye)
- use modifier -79 if you are initiating post-operative care for the second eye during the global period of the first eye's cataract surgery post-op care
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| Example of a cataract post-op claim filed to BCBS. This claim was approved and paid by insurance! |
- Initial Treatment Date: this is date of SURGERY not the date that you initiate care for post-op visits!
- Place of Service (pick 11 "office" in most cases of primary eyecare setting)
- Units = 1
- Box 17 = Referring surgeon’s name and NPI (I have had good success just listing the referring provider's name)
- Box 19 = Dates of assumed care. The first date is the date you see the patient for your first post-op visit; the last date is the final date in the 90 day global period*
- Remember to link the CPT service code to the diagnosis code for cataract that was used by the surgeon at the time of surgery!
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| Note in the additional claim information section you put the referring doctor (Box 17), initial treatment date (SURGERY DATE!), report care start date is your first day of post-op care, and report care end date is the last day of the 90 day global period. I always spell it all out in Box 19 too. |
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