Ophthalmology and Optometry Coding Alert

Question: We got a patient for a PRK follow-up exam. He had the surgery done at another facility, so what would be included in a PRK follow-up exam? This is the first time we are seeing the patient. How should we code the procedure?

Arkansas Subscriber

Answer: You do not need to file a claim for follow-up care. Most payers, including Medicare, do not cover PRK (photorefractive keratotomy). You can simply use an internal code for PRK and collect directly from the patient or the surgical center.

The follow-up is not a procedure -- it is an office visit, which the insurer will probably deny due to diagnosis of pre-operative care following PRK. The patient will probably need to pay out-of-pocket for the follow-up office visit care. Inform the patient that the payer may not cover an office visit for follow-up care of a non-covered procedure (PRK) that another physician provided, and that your practice expects payment from the patient at the time the ophthalmologist renders the service.