ASC Ophthalmology Focus: Here’s How to Avoid a Crucial Laser Treatment Coding Mistake

You may report 67228 and 67210 separately, in some cases
If you’re relying on the diagnosis code to point you in the right direction when choosing between laser treatment codes 67228 and 67210, you could be setting yourself up for mistakes. Ensure you pick the right code every time with this expert advice.

Look Beyond the Diagnosis

Determining when a situation requires 67228 (Treatment of extensive or progressive retinopathy, one or more sessions [e.g., diabetic retinopathy], photocoagulation: APC 0247) instead of 67210 (Destruction of localized lesion of retina [e.g., macular edema, tumors], one or more sessions; photocoagulation: APC 0247) isn’t complicated, as long as the ophthalmologist provides documentation of the utmost specificity.
Code 67210 represents a focal or grid photocoagulation laser, whereas 67228 represents a panretinal (encompassing the entire retina) photocoagulation laser, says Byrd Evans, COE, OCS, senior consultant with Advantage Administration in Dallas.
Bottom line: Code 67228 represents a procedure for treating vessels, and 67210 is for lesions or masses, says Becky Zellmer, CPC, MBS, CBCS, provider educator/ chart review for Prevea Health in Green Bay, Wis. "The main difference in the documentation should be lesion versus vessels."
It’s in the details: The procedure described in 67228 seals the vessels in the retina so that they no longer leak. Code 67210 represents the procedure ophthalmologists use for lesions that occur on the retina, Zellmer says. "The lesions can be related to diabetic retinopathy, but the documentation should state ‘lesion.’ I have seen 67228 most often referred to as ‘scattered destruction.’ "
Tip: When you’re scanning the documentation, if the ophthalmologist mentions she entered the posterior chamber, you should choose 67228. "With 67210, the physicians should not be entering the posterior chamber. With 67228, they may enter the posterior chamber," Zellmer says.
Pitfall: You may think that the diagnosis the ophthalmologist dictates will lead you to the proper procedure code. The ophthalmologist can use 67228 to treat both background (362.01) and proliferative diabetic retinopathy (362.02), but he wouldn’t use 67210 to treat either of these conditions, Zellmer says. Your physician may use either procedure to treat retinal edema (362.83) and use 67228 to treat retinal ischemia (362.84). Therefore, you shouldn’t use the diagnosis "as the determining factor to decide which code is appropriate," Zellmer adds.

Unbundle With Proper Documentation

The national Correct Coding Initiative (CCI) edits bundle 67210 and 67228, indicating that they are mutually exclusive of one another. This bundle carries a modifier indicator of "1," however, meaning that CMS allows a modifier to override the edit if circumstances warrant it.
Example: If the ophthalmologist performs the procedures [...]

- Published on 2008-03-14