Ophthalmology and Optometry Coding Alert

Question: One of our doctors has started performing the corneal limbal relaxing procedure for elective purposes. What CPT code should we use to 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 an appropriate code to use for this procedure. But this code only applies to surgically induced astigmatism.

If the astigmatism is not surgically induced, the procedure is generally a noncovered elective refractive surgery. So if the ophthalmologist wants to correct pre-existing 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 won't 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 should never obtain an advance beneficiary notice (ABN) for a service that Medicare deems a noncovered service. Therefore, you would only append modifier GY to the service. The patient is always responsible for payment of a procedure that is never covered. Of course, your practice should inform the patient of this circumstance in advance, but obtaining an ABN is not the way to do so. Use an ABN for services that are usually covered but the circumstance is such that the carrier will not cover service due to diagnosis, frequency-of-service limitations, etc.