Ophthalmology and Optometry Coding Alert

In the article Optimize Reimbursement for Photodynamic Therapy (PDT) in the August 2000 issue of Ophthalmology Coding Alert, we covered the ever-changing picture for billing PDT. We erroneously said that Visudyne is injected into the eye. It is not. It is injected into a vein, and the drug then takes effect systemically. The vascular network of the eye is included in this effect. We apologize for the error.

In addition, we said that the laser cost approximately $80,000, whereas quotes from PDT laser manufacturers Zeiss and Coherent are both more like $40,000, according to Michael Stewart, MD, a retinologist who practices at the Mayo Clinic in Jacksonville, Fla.

Stewart also believes that more than one treatment is an understatement. In reality, patients average 3.4 treatments the first year and 2.1 treatments the second year after initiation of PDT, says Stewart. Therefore, one has to expect multiple treatments over a prolonged period of time, something for which the physician, staff and patient have to be prepared.

Finally, in the context of the article, PDT is for the treatment of predominantly classic choroidal neovascular membranes, while transpupillary thermal therapy (TTT) is for the treatment of predominantly occult choroidal neovascular membranes. Both are for age-related macular degeneration.

Meanwhile, look for a coverage policy from your local Medicare carrier and recommended method for billing the procedure, the drug and the infusion. The Health Care Financing Administration (HCFA) initially advised carriers to instruct providers to use 67299 (unlisted procedure, posterior segment) for the laser, the drug and the infusion therapy, says Raequell Duran, president of Practice Solutions, a coding, compliance and reimbursement consulting company based in Santa Barbara, Calif.

Since then, says Duran, who specializes in ophthalmology, in a new program memorandum dated Sept. 1, HCFA advised carriers that Visudyne has been approved for inclusion in the United States Pharmacopoeia (USP) and for services beginning July 18, to pay for the drug with HCPCS code J3490. Many carriers, notes Duran, had already published their policy prior to the new memorandum in their September Medicare bulletins. This is why it is so important to contact your local carrier to verify that you have the most current policy.