Ophthalmology and Optometry Coding Alert

Question: Can you help me code this scenario? The patient had a recurrent problem with Von Hipple aneurysms in the left eye, and had developed three new aneurysms, which resulted in leakage and fluid accumulation around his paracentral region. The ophthalmologist performed focal argon green laser treatment for macular aneurysms.

Procedure notes: The patient was brought in through the laser room. The eye had already been dilated with 1% Mydriacyl and 2.5% Neo-Synephrine. A drop of Alcaine was placed in the eye, and a Goldmann 3-mirror lens was coupled to the eye using Goniosol. Using a 200 micron spot size at 0.1 second durations, 0.17 watts of power in a single burst mode 127 spots used to coagulate microaneurysms, supratemporal, and supranasal and inferonasal to the fovea along the arcades for two large aneurysms.

Florida Subscriber

Answer: Your best bet would be to report unlisted code 67299 (Unlisted procedure, posterior segment). Submission of this code would be subject to a manual claim review, and the documentation of the operative note, along with an explanation in layman’s terms of the work performed, should be included.

Pricing the procedure is another problem, and the physician should consider work effort, time, and resources to determine the value of the service to suggest a fee.

Caveat: Last but not least is whether or not the treatment is approved by the FDA or is considered experimental. Use of laser photocoagulation has been considered an approved procedure for many years, so perhaps this will not be an issue by payers. However, there do not seem to be any specific guidelines as to whether the use of the laser for macular aneurysms was experimental or not.