Ophthalmology and Optometry Coding Alert

" LASIK (laser-assisted in situ keratomileusis) is a high-paying refractive procedure and is not covered by most insurance plans, including Medicare. In some instances, LASIK is considered a self-pay procedure, or it may be covered by insurance. There is no CPT code specifically for LASIK.
 
To bill the procedure correctly, according to CPT convention, use 66999 (unlisted procedure, anterior segment of eye) unless the payer gives instructions in writing to use a different code. You may code 66999 for any insurance-covered LASIK procedure where instructions for coding have not yet been issued by the payer and if the patient is paying for the entire procedure out-of-pocket, but many plans that cover LASIK require 65760 (keratomileusis).
 
According to CPT , this code is technically incorrect, but the payer has the right to make exceptions for which codes it will reimburse. If" in fact there is documentation from the payer saying to use that code such as a payer newsletter or letter it's OK to use it " says Lise Roberts vice president of Health Care Compliance Strategies a Jericho N.Y.-based company that develops interactive compliance training courses. If the payer audits you and finds out you have been billing 65760 for LASIK it  cannot accuse you of billing fraudulently. "They will have no recourse because you have the newsletter or letter from them on file telling you to bill LASIK with 65760 "  Roberts says.
LASIK versus Keratomileusis  
Although "keratomileusis" is a component of the acronym LASIK many coders believe 65760 may be used when coding the LASIK procedure but it is not appropriate. The descriptor for 65760 does not include what is done for LASIK says Michael X. Repka MD American Academy of Ophthalmologists' advisor to the AMA CPT advisory committee. If a payer requests that you use the code that is what you should do he says. In fact keratomileusis is no longer performed making 65760 an obsolete code. LASIK is now considered the standard practice.
 
LASIK is a less complicated procedure than keratomileusis. With LASIK the ophthalmologist uses a knife to cut a flap in the cornea. The surgeon lifts the flap and then uses an excimer laser which is controlled by a computer to flatten the underlying cornea. The surgeon then replaces the flap and the cornea heals without stitches. Performed under local anesthesia LASIK is popular because of rapid healing and quick return of vision. As with all surgeries there is always risk.
 
A true keratomileusis procedure on the other hand involves shaving off a section of the cornea with a knife reducing it with laser [...]