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Ophthalmology and Optometry Coding Alert

Reader Questions:

Skip PRK Follow-Up by Second Ophthalmologist

Published on Tue Aug 26, 2008

Question: We got a patient for a PRK follow-up exam. He had the surgery done at another facility, so what would be included in a PRK follow-up exam? This is the first time we are seeing the patient. How should we code the procedure?Arkansas SubscriberAnswer: You do not need to file a claim for follow-up care. Most payers, including Medicare, do not cover PRK (photorefractive keratotomy). You can simply use an internal code for PRK and collect directly from the patient or the surgical center.The follow-up is not a procedure -- it is an office visit, which the insurer will probably deny due to diagnosis of pre-operative care following PRK. The patient will probably need to pay out-of-pocket for the follow-up office visit care. Inform the patient that the payer may not cover an office visit for follow-up care of a non-covered procedure (PRK) that another physician provided, and that your practice expects payment from the patient at the time the ophthalmologist renders the service.
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