Ophthalmology and Optometry Coding Alert

Question: What is the proper way to bill and be paid for a Ytrium-Aluminim-Garnet (YAG) performed on both eyes?

Wisconsin Subscriber

Answer: This surgery, rarely done on both eyes the same day, is billable when done bilaterally one of two ways.

1. Code 66821-RT (discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages] -right side) on the first line, and 66821-LT (-left side) on the second line, with one unit on each line and your normal fee on each line. Medicare will pay you 100 percent for the first line, and 50 percent for the second. You do not need to use modifier -51 (multiple procedures) because Medicare will make the allowance automatically.

2. Code 66821-50 (bilateral procedure) on one line, but double your normal fee.

In either case, bill your full fee for each eye. If you try to make the adjustment and lower the fee for the second eye, you run the risk of Medicare lowering it again.

Carriers must follow the Peer Review Organizations (PROs) policy on the appropriateness of time intervals between procedures. PROs have varying rules regarding this procedure: Some require 60 days between eyes, and some require 90 days. If you perform the procedure the same day in both eyes, be ready to submit documentation explaining why, and make sure you know the PRO policy in your area.

Answers to You Be the Coder and Reader Questions contributed by Raequell Duran, president, Practice Solutions, ophthalmology coding and compliance consultant, Santa Barbara, Calif.; Michael X. Repka, MD, American Academy of Ophthalmology advisor to AMA CPT Advisory Committee; and Lise Roberts, vice president, Health Care Compliance Strategies, Syosset, N.Y.