Ophthalmology and Optometry Coding Alert

Question: Is there any way we can receive reimbursement for doing a conductive keratoplasty? Texas Subscriber Answer: Although it is not reimbursable by Medicare and many private payers, some carriers may pay claims submitted for keratoplasty, which means it's worth checking your LMRP. Conductive keratoplasty (CK) is a three-minute procedure that reshapes the cornea to increase focusing power by applying radio frequency (RF) energy via a very thin keratoplast tip. Its major use is to correct hyperopia, or farsightedness, in people over the age of 40. It uses no laser, so the surgeon does not remove tissue, operate over the line of sight, or use any blades.

The procedure involves applying a topical anesthetic and placing a lid speculum, which is attached to the CK device and serves to ground the energy. The surgeon then marks the eye treatment spots in a ring pattern; this pattern lasts throughout the treatment. The surgeon places the keratoplast tip directly on the spots and releases energy directly into the corneal tissue. As the tip penetrates the cornea to a depth of 450 microns, the periphery of the cornea is drawn up and the central part is steepened. This collagen shrinkage changes the eye curvature. In some patients, the eye may fail to retain its new shape, thus losing some of the improvements made by the procedure. In April 2002, the FDA approved CK to treat low-tomoderate hyperopia 367.0 (Hypermetropia; Farsightedness, hyperopia) without astigmatism. It is also undergoing clinical trials for treatment of presbyopia; this is strictly off-label. Medicare does not reimburse for this procedure when it's used for refractive error compensation, considering it a "substitute or alternative to eyeglasses or contact lenses, which are specifically excluded from coverage." Private payers tend to take the same stance, and many consider it to be refractive surgery in the same category as cosmetic surgery, which is also not covered for reimbursement. Although CK is used strictly as a refractive procedure and is not reimbursed by Medicare and most non- Medicare payers, for particular non-Medicare patients some insurance companies may offer a discount. In these cases, bill the procedure as 66999 (Unlisted procedure, anterior segment of eye) and carefully document what was done. It's important to check the particular benefit plan to ascertain whether any such discounts are available. And, as always, when charging a patient for a noncovered service, it is best to have the patient sign an agreement or waiver describing the service and the amount of money the patient will be responsible for paying. .