Ophthalmology and Optometry Coding Alert

Question: One of our patients has pigmented pupillary membrane and has never had cataract surgery. Our physician plans to use the YAG laser to break that up and hopefully restore part of the patient’s vision. The doctor wants to use 66821 which is not correct, because the code descriptor says “secondary membranous cataract” which indicates the condition is a result of a recent cataract surgery. Can you give advice on the proper code to use?

Codify Subscriber

Answer: You are correct in not choosing 66821 (Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages)). Many providers use 66600 (Iridectomy, with corneoscleral or corneal section; for removal of lesion) for the removal of the affected pupillary membrane.

You’ll need to review the note carefully to ensure that the documentation supports the clinical responsibility for code 66600. For this service, the provider makes a small incision in the cornea. He then places a special magnification lens on the eye of the patient and directs the YAG (Yttrium-aluminum-garnet) laser beam through it to the iris. This laser beam excises a part of the iris and destroys the lesion on it. If those details match your operative note, you can bill code 66600.

Alternative: If you don’t have those details for the membrane removal, you’ll need to report 66999 (Unlisted procedure, anterior segment of eye). Be sure to attach copy of operative report with bill to justify the claim.