Ophthalmology and Optometry Coding Alert

LASIK, PRK and PTK are three laser refractive keratoplasty procedures that have a problem: The procedures don't have CPT codes. Laser-assisted in situ keratomileusis (LASIK), photore-fractive keratectomy (PRK), and phototherapeutic keratectomy (PTK) are three keratoplasty procedures that are considered by Medicare and many insurance companies still to be "experimental," says Susan Callaway, CPC, CCS-P, an independent coding consultant in North Augusta, S.C. Placing procedures in the experimental category is simply a way to indicate that they have not yet shown enough consistent results, she says. LASIK uses a laser to reduce curvature and correct nearsightedness, and because the corneal tissue has natural bonding qualities the eye heals without stitches. PRK uses a laser to treat nearsightedness and requires a preoperative consultation with a refractive surgeon to take a series of measurements and tests to determine your degree of nearsightedness and astigmatism (-1.5 to -7.0 diopters myopia with astigmatism no greater than 1.5 diopters) and to check the overall health of the eyes and to take a corneal map. And PTK is a corneal laser treatment that removes layers of corneal clouding and clears patients' vision when successful. By and large, Medicare and many insurance companies don't cover correction of vision, which is exactly what these laser procedures are designed to do, Callaway says, because they consider these treatments cosmetic. Submitting Unlisted-Procedure Codes What this means to you: If you combine the fact that LASIK, PRK and PTK don't have specific CPT codes to represent their services with the fact that many carriers consider these procedures experimental and cosmetic, your job as a coder just got harder. How should you handle claims for LASIK, PRK and PTK? Your best bet is to submit the unlisted-procedure code for the anterior segment of the eye: 66999. Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J., gives you these reasons why:
If there is no code for the procedure you are coding, proper coding provides for the use of the appropriate unlisted-procedure code rather than a code for a comparable service.
If you don't use the unlisted-procedure code, you will be unable to track how many times these procedures were performed in your practice, a piece of data that could be helpful in eventually establishing CPT codes for these procedures. The AMA guides coders to use the unlisted-procedure codes so carriers can track the frequency of these procedures and gauge the necessity for new CPT codes

Also, you have to be careful not to misrepresent the service provided. Using an unlisted-procedure code and providing a description of the procedure will help to ensure that you don't have to return money to insurers for a service they didn't intend to cover. [...]