Ophthalmology and Optometry Coding Alert

Question: One week after my ophthalmologist performed panretinal photocoagulation on a patient, the patient returned for a repeat of the initial procedure. How do I know if this is separately billable or included in the global surgical package of the first panretinal photocoagulation?

Texas Subscriber

Answer: If your ophthalmologist performs a repeat laser procedure in the postoperative period, don't expect be reimbursed unless the second laser treatment is for a new problem, or the opposite eye is being treated.

Getting reimbursed for repeat laser treatments is tricky because of two things: the inclusion of "one or more sessions" in the descriptors for laser CPT codes, and Medicare's policy that says subsequent laser treatments within the postoperative period will not be reimbursed if the same laser procedure code and initial diagnosis code are reported for the subsequent service.

With panretinal photocoagulation, Medicare and many other payers do not consider newly identified lesions in the same eye to be a new problem because they require the same diagnosis code. Therefore, using a modifier -58, -78 or -79 to get paid for the second 67228 (Destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions; photocoagu-lation) service when the initial and subsequent diagnosis codes are the same is inappropriate coding.

On the other hand, let's look at a situation that involves laser procedure code 67220 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photocoagulation [e.g., laser], one or more sessions). A patient presents with a choroidal net that is treated with 67220, and two weeks later the same patient presents with a second choroidal net in the other eye. The second 67220 service is separately billable with modifier -79 (Unrelated procedure or service by the same physician during the postoperative period), which indicates that the second laser procedure is unrelated to the first laser procedure.