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Ophthalmology and Optometry Coding Alert

Reader Question:

Supporting Medical Necessity

Published on Fri Oct 01, 1999

Question: What diagnosis codes support medical necessity for 67220?

Anonymous IL Subscriber

Answer: This is a new code for 1999. Code 67220 is destruction of localized lesion of choroid (e.g., choroidal neovascularization), one or more session, photocoagulation (laser). There are three main diagnosis codes that should support 67220: 362.16 (retinal neovascularization NOS) and, most commonly, the age-related macular degeneration ICD-9 codes, which are 362.51 and 362.52. Even though 67220 is usually done in the office, it is considered major surgery and has a postoperative period of 90 days. That means that if you perform the procedure, and then there is a recurrence within the postoperative period and you need to do it again, you cant bill for it again because it is described in CPT as being done in one or more sessions.
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