Wiki Please help clarify 66821

[cherylbr]

We have a patient that had yag caps (66821) done on the right eye 6/02/19.
Same patient had yag caps (66821) done again on the right eye 6-30-19. We billed this procedure with a 76 modifier.

Medicare is denying this.

When I look at the procedure description on my software it mentions "the provider should not have additional billing because this code represents one or more sessions."

Does that mean we cannot bill/charge for any additional 66821 after the first one?

Thank you!
Cheryl B.

 

[jareardon]

Typically Medicare will only allow once per lifetime per eye (secondary to cataract extraction), so that is one issue; doing the same eye again inside the global is another. When a code states "one or more sessions", you can only bill the first session during the global period, unless for an unrelated condition.

Hope this helps!
David Keown, CPC, OCS

Could this be billed with a 78 modifer?

 

[dkeown]

We have a patient that had yag caps (66821) done on the right eye 6/02/19.
Same patient had yag caps (66821) done again on the right eye 6-30-19. We billed this procedure with a 76 modifier.

Medicare is denying this.

When I look at the procedure description on my software it mentions "the provider should not have additional billing because this code represents one or more sessions."

Does that mean we cannot bill/charge for any additional 66821 after the first one?

Thank you!
Cheryl B.

Typically Medicare will only allow once per lifetime per eye (secondary to cataract extraction), so that is one issue; doing the same eye again inside the global is another. When a code states "one or more sessions", you can only bill the first session during the global period, unless for an unrelated condition.

Hope this helps!
David Keown, CPC, OCS