Ophthalmology and Optometry Coding Alert

Question: One of our physicians was performing a laser treatment on a patient's retina and had to discontinue the procedure before finishing because of a decline in the patient's health. The physician finished the procedure two weeks later. How should I bill for the discontinued procedure and the subsequent successful procedure? Which modifiers must be appended to the completed procedure code?

Florida Subscriber

Answer: Even though it may seem as if modifier -53 (Discontinued procedure) is necessary for the initial procedure code, don't be fooled most eye and ocular adnexa laser procedure codes have their own set of multiple-session guidelines.

For example, a physician performs laser treatment of the patient's left choroid, 67220 (Destruction of localized lesion of choroids [e.g., choroidal neovascularization]; photocoagulation [e.g., laser], one or more sessions), and is forced to discontinue the procedure when the patient is unable to tolerate the procedure. The patient returns a week later, but again the physician is unable to complete the procedure due to the patient's discomfort. Finally the procedure is completed in the third session. To bill for all of these sessions, you need to submit 67220 only once with the left eye modifier -LT.

Why doesn't the physician bill 67220-53-LT? The definition of the code specifically states "one or more sessions." And according to "Principles of CPT Coding," when the phrase "one or more sessions" appears in a code descriptor, "the code should be reported only once for the entire defined treatment period, regardless of the number of sessions necessary to complete the treatment." It is the physician who determines the defined treatment period depending on the patient, diagnosis, and area to be treated.