Ophthalmology and Optometry Coding Alert

Answer: Ocular photodynamic therapy (OPT), a noninvasive treatment for age-related macular degeneration, is a procedure that relies on the ability of a photoactive drug, activated by laser light, to destroy the cells the laser light has targeted. OPT, 67221 (Destruction of localized lesion ... photodynamic therapy [includes intravenous infusion]), involves less work intensity and has a lower risk of complications than its parallel laser surgery, laser photocoagulation (67220), which makes OPT in both eyes during a single session feasible.

Consequently, when OPT is performed bilaterally you cannot simply append modifier -50 to indicate a bilateral procedure. It is not uncommon for coders to forget that photodynamic therapy has an add-on code that should be used in place of the bilateral modifier. Mistakenly billing 67221-50 in place of +67225 (... photodynamic therapy, second eye, at a single session [list separately in addition to code for primary eye treatment]) can be considered fraud.