Ophthalmology and Optometry Coding Alert

Question: What is the criteria for payment by Medicare for correction of a surgically induced astigmatism? What are the appropriate procedure and diagnosis codes?

Florida Subscriber

Answer: If there is specific criteria for payment by Medicare, namely ICD-9 and CPT codes, it should be documented in your local Medicare carriers manual or on their Web site. Many Medicare carriers have specified a minimum amount of surgically induced astigmatism that is necessary before surgical correction of it will be considered medically necessary. CPT 2000 has two codes that pertain to correction of surgically induced astigmatism: Code 65772 (corneal relaxing incision for correction of surgically induced astigmatism) and 65775 (corneal wedge resection for correction of surgically induced astigmatism).

If the surgical correction of the surgically induced astigmatism is done during a global period, you will need to append the -78 modifier (return to the operating room for a related procedure during the postoperative period) to receive reimbursement. The appropriate ICD-9 code depends on the type of astigmatism: Code 367.20 is for an unspecified astigmatism. This code should be used with caution because it is a nonspecific code. Code 367.21 is for a regular astigmatism and 367.22 is for an irregular astigmatism. Because the astigmatism was surgically induced, meaning the patient had previous eye surgery, a V-code should be used as a secondary code to indicate previous surgery. Code V45.69 indicates other states following surgery of the eye and adnexa.