Ophthalmology and Optometry Coding Alert

Question: A patient has deposits of pigment on the anterior lens surface -- an implant -- of the right eye, necessitating laser removal every six months. Tardive dyskinesia makes it impossible for the patient to hold still; consequently, there are some pits in the implant. Which CPT code should we use -- 65920 or 66821?

Julia Bannan, Office Manager
Raymond A. Bannan, MD, Wheeling, WV

Answer: The closest code you can use is 66821 (discission of secondary membranous cataract, opacified posterior lens capsule and/or anterior hyaloid; laser surgery [eg, YAG laser], one or more stages). It is a little dangerous to use this code because many payers consider that once youve opened the secondary membrane, its done already. The payers think you shouldnt have to do it every six months; so this could trigger an audit. But in this case, you are technically doing something a little different than 66821. And you have to do this repeatedly because of the patients condition. So you will need to append a -22 modifier (unusual services) to alert the payer. Also, it would be good to have a standard cover letter designed that you can send back if this code is challenged or denied, explaining the status of the patient. The diagnosis code should be 996.53 (complications of implant).