Ophthalmology and Optometry Coding Alert

Question: When our ophthalmologist performs surgery reported with a code whose descriptor states “one or more sessions,” and they must repeat the procedure during the 90-day global period, can we bill and have the patient pay for the second procedure after having them sign an Advance Beneficiary Notice (ABN)? What surgeries might this pertain to?

Connecticut Subscriber

Answer: Under no circumstance should you charge the patient for a repeat procedure when the code for the surgery includes “one or more sessions” in its descriptor. A few examples of CPT^® codes that include this language include:

• 66821 (Discission of secondary membranous cataract … laser surgery (eg, YAG laser) (1 or more stages))
• 67208 (Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; cryotherapy, diathermy)
• 67210 (… photocoagulation)
• 67218 (… radiation by implantation of source (includes removal of source))
• 67220 (Destruction of localized lesion of choroid … photocoagulation (eg, laser), 1 or more sessions)

When the code specifies one or more sessions, you cannot bill for additional sessions performed during the global period. If you do, Medicare might interpret this as an attempt to commit fraud and as inappropriate use of an ABN.

Remember: Medicare Part B payment is for the entire 90-day period no matter how many additional times the physician must perform the procedure.