Ophthalmology and Optometry Coding Alert

Question: If a physician treats a patient with the PRP (panretinal photocoagulation) laser in multiple sessions over a six-month period, how should we code each session?

Texas Subscriber

Answer: Code 67228 (destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions; photocoagulation [laser or xenon arc]) has a 90-day postoperative period per eye. The code says one or more sessions, so you can only bill for one session per eye per 90 days. This means that if a patient were to have multiple laser treatments on the same eye in a six-month period, you would be able to submit a bill only for the initial treatment, and the treatment that was rendered following 90 days of the first procedure. As an example, if the first PRP laser treatment was rendered on March 1, you could not bill a subsequent PRP laser treatment until after May 30. This is regardless of the number of treatments rendered between the first treatment and the end of the 90-day period.

If the patient has 67228 on one eye and comes in during the 90-day postoperative period for the same treatment on the other eye, you could bill for that 67228 with modifier -79 (unrelated procedure or service by the same physician during the postoperative period).

This is a good example why, when billing for surgeries, you should always indicate which eye is being treated with the -LT or -RT modifiers appended to the code (67228, in this case). Therefore, you would code 67228-LT for a PRP performed on the left eye first, and 67228-79-RT for a PRP performed on the right eye during the postoperative period for the one that was performed on the left eye. The numeric modifier should always be the first one appended to the code and then the eye modifier.