Ophthalmology and Optometry Coding Alert

Question: One of our doctors has started performing the corneal limbal relaxing procedure for elective purposes. Which CPT code should we use to correctly report this procedure?

New Hampshire Subscriber

Answer: You should report elective corneal limbal relaxation procedures using 66999-GY (Unlisted procedure, anterior segment of eye; Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit).

Caution: You may think 65772 (Corneal relaxing incision for correction of surgically induced astigmatism) sounds like the correct and appropriate code to use for this procedure. But this code applies only to surgicallyinduced astigmatism.

If the astigmatism is not surgically induced, the procedure is generally a noncovered elective refractive surgery. So if the ophthalmologist wants to correct preexisting astigmatism at the same time he removes cataracts by doing the corneal limbal relaxation along with the cataract surgery, for example, you should inform the patient that Medicare isn't going to cover the relaxation procedure.

Tip: When you append modifier GY to 66999, you're telling Medicare that although the service is not covered, you're submitting the claim to obtain a denial to submit to the patient's secondary insurance or that the patient specifically requested you to submit the claim.

Pitfall: You are not required to obtain an advance beneficiary notice (ABN) for a service that Medicare deems a non-covered service. Therefore, you would append only modifier GY to the service. The patient is always responsible for payment of a procedure that is never covered.

Informing the patient of possible Medicare denials in advance makes good sense for your practice, and you are allowed to use the new ABN form to advise the patient of his expected financial obligation. When Medicare revised the new ABN, they eliminated the Notice of Exclusion from Medicare Benefits (NEMB) form and have instructed providers that they may use the new ABN for this purpose. You must also use an ABN for services that are usually covered but the circumstance is such that the carrier will not cover the service due to diagnosis or frequency-ofservice limitations, among other reasons.