Ophthalmology and Optometry Coding Alert
Understand Surgically Induced Versus Pre-Existing Astigmatism
Florida Subscriber
Answer: Since your patient's astigmatism is surgically induced, use 65772 (Corneal relaxing procedure for correction of surgically induced astigmatism) for the AK procedure. Cataract surgery can result in major astigmatism because the shape of the cornea may be significantly altered during a patient's postoperative healing process.
It is important to note that 65772 does not encompass pre-existing astigmatism. If the astigmatism is not surgically induced, the procedure is generally a noncovered elective refractive surgery. So, if the opthalmologist wants to correct pre-existing astigmatism at the same time he removes cataracts by doing an AK along with the cataract surgery, you should inform the patient that Medicare won't cover the AK.
Have the patient sign a waiver, and submit 66999-GY (Unlisted procedure, anterior segment of eye; item or service statutorily excluded or does not meet the definition of any Medicare benefit) along with the code for the cataract procedure.
Medicare will send the patient an explanation of benefits (EOB) showing payment for the cataract surgery and denial as noncovered for the AK. Please see "Get Paid for Glaucoma Screenings for Low-Risk Patients" on page 28 for more information on waivers, modifiers and EOBs.
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