Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist performed a corneal relaxation incision at the time of cataract surgery, to correct a case of pre-existing astigmatism. But the description of 65772 says it's for surgically induced astigmatism. Can I still report that code at the same time as 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis ...)?


Illinois Subscriber


Answer: Bill the astigmatic keratotomy (AK) with code 66999-GY-GA (Unlisted procedure, anterior segment of eye; item or service statutorily excluded or does not meet the definition of any Medicare benefit; waiver of liability on file) along with the code for the cataract procedure. Code 65772 does not encompass pre-existing 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 an AK along with the cataract surgery, you should inform the patient that Medicare won't cover the AK.

Strategy: The -GY modifier appended to 66999 tells Medicare that although the service is not covered, you're submitting the claim in order to obtain a denial to submit to the patient's secondary insurance - or that the patient specifically requested you to submit the claim. You may wish to have the patient sign an advance beneficiary notice (ABN). The -GA modifier lets the carrier know you have obtained it and that it is on file at your practice. However, it would be appropriate to notify the patient that the service will not be paid by Medicare and that he will have to pay for this service.

Medicare will send the patient an explanation of benefits (EOB) showing payment for the cataract surgery and denial as noncovered for the AK.