Ophthalmology and Optometry Coding Alert

Question: My physician is planning to perform endoscopic cilliary photocoagulation, but I cannot decide how to code it properly. The closest CPT codes appear to be 66761 and 66762. Are these codes correct?

Pennsylvania Subscriber

Answer: Endoscopic cilliary photocoagulation coding stumps even the best coders because there is no single code or combination of codes that accurately captures the procedure, but you are on the right track. The American Society of Cataract & Refractive Surgery offers the following methods of coding ECPs.

If the procedure is being performed stand-alone, such as in a pseudophake, you should use 65875 (Severing adhesions of anterior segment of eye, incisional technique [with or without injection of air or liquid][separate procedure]; posterior synechiae) and 66710 (Cilliary body destruction; cyclophotocoagulation).

The synechiolysis code, 65875, is used with the rationale that it is the closest code to reflect the ECP's creation of a space from a potential space by visco dissection. The justification for coding 66710 is that the cyclophotocoagulation code is also used to code extraocular photocoagulation.

If you combine ECP with phacoemulsification, you should code 66710 and 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage). In this case, the cataract surgery that requires the use of the endoscope validates the complex cataract code 66982. Code 66982 would not apply if the sole purpose of the endoscope were for lasering the CB processes.