Optometry Coding & Billing Alert

Published on Wed Apr 28, 2010 PDF

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?

Alaska Subscriber

Answer: 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. That is something that should have been discussed before the appointment as most laser centers work on a "one fee for everything" policy, so if the patient goes elsewhere, he will probably have to pay for it himself.

Exception: If a patient requests that you can send a claim to Medicare, report 66999-GY (Unlisted procedure, anterior segment of eye; Item or service statutorily excluded, does  not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit), with a description in Item 19 of the CMS-1500 form.