Ophthalmology and Optometry Coding Alert

Reader Question:

66821 Works Again for Repeat YAG Capsulotomy

Published on Thu Jan 13, 2011

Question: The doctor performed a YAG laser capsulotomy. Six months later, during a return visit, the patient noted glare, light sensitivity, and decreased vision. The exam showed Elschnig's pearls, and the YAG opening was now smaller than the undilated pupil. The doctor performed a repeat YAG capsulotomy on the same eye. How should we code this? Will the procedure be reimbursed?

Florida Subscriber

Answer: Because the second procedure happened outside the 90-day global period for the initial yttrium aluminum garnet (YAG) laser procedure, just report the same code (66821, Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]) without any modifiers. As long as it was documented and supports medical necessity, you should have no problem with reimbursement.

You can report only one YAG performed on the same eye within the 90-day global period. The phrase "one or more stages" in 66821's definition means that the code includes any number of subsequent YAG sessions within the 90-day global period.

Diagnosis: In the ICD-9 manual index, "Elschnig bodies or pearls" directs you to code 366.51 (Aftercataract; Soemmering's ring).

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