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Ophthalmology and Optometry Coding Alert

Reader Question:

Link 362.83 to Focal Laser Treatment Code

Published on Fri Feb 20, 2004

Question: One of our patients with background diabetic retinopathy (BDR) presented with a small area of edema from leaking vessels. The ophthalmologist used a focal laser to seal off the leaking blood vessels. We reported use of the focal laser (67210) with a diagnosis of diabetic retinopathy and were rejected by Medicare. Should I appeal? What did I do wrong?

Texas Subscriber Answer: Your procedural code is correct (67210, Destruction of localized lesion of retina [e.g., macular edema, tumors], one or more sessions; photocoagulation) but this procedure is specifically a treatment for retinal edema (362.83, Other retinal disorders; retinal edema), not BDR.

The ophthalmologist is using the focal laser to treat the edema, not the diabetic retinopathy.
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