Ophthalmology and Optometry Coding Alert

Question: If a surgeon is performing a lensectomy as an alternative to LASIK treatment for correction of visual acuity, and billing 66999, and doing the procedure in an ambulatory surgery center, can he charge anything he wants for this? Are there any compliance issues? This is a cosmetic procedure.

Anonymous Florida Subscriber

Answer: If this is a cosmetic procedure, and the surgeon is using 66999 (unlisted procedure, anterior segment of eye), then yes, he or she can charge whatever he or she wants. However, the surgeon must be careful to document that the patient was informed of the cosmetic nature of the service, and that the patient will be responsible for the charges.

Sometimes the patient will insist that a claim be filed with the insurance carrierMedicare or commercialeven if the company will not pay for a procedure. The patient, for whatever reason, doesnt want to pay until the proof that the insurance company wont pay is in black and white. But if you do it this way in this case, since you are filing 66999a code that is for any unlisted anterior segment procedure and doesnt specify lensectomy or the purpose of the procedureyou must file a paper claim with an attachment describing the procedure and its cosmetic nature.