Optometry Coding & Billing 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?

Alaska 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.

Exception: If a patient requests that you can send a claim to Medicare, report 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), with a description in Item 19 of the CMS-1500 form.