Outpatient Facility Coding Alert
Keep the Global Period in Mind When Using 66821 For the Same Eye
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Question: The ophthalmologist performed a YAG laser capsulotomy. The patient on a return visit, after 6 months complained of glare, light sensitivity, and decreased vision. The exam showed Elschnig’s pearls, and the YAG opening was now smaller than the undilated pupil. The doctor performed a repeat YAG capsulotomy on the same eye. Will the procedure be reimbursed? How should we code this?
Georgia Subscriber
Answer: Since the second procedure happened outside the 90-day global period for the initial yttrium aluminum garnet (YAG) laser procedure, you can report the same code 66821 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]) with modifier LT (Left side) or RT (Right side). No other modifiers are needed. As long as it was documented and supports medical necessity, you should have no problem with reimbursement.
Remember:
You can report only one YAG performed on the same eye within the 90-day global period. The phrase “one or more stages” in 66821’s definition means that the code includes any number of subsequent YAG sessions within the 90-day global period.
Diagnosis: In the ICD-9 manual index, “Elschnig bodies or pearls” directs you to code 366.51 (After-cataract; Soemmering’s ring)
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