Part B Insider (Multispecialty) Coding Alert

Published on Sun May 28, 2006 PDF

AK fixes can earn your practice money--if Medicare deems them medically necessary

Correcting astigmatic keratotomy (AK) isn’t always cosmetic; many times, attaching the right ICD-9 Codes to your claims can capture reimbursement. Here’s why.

Ophthalmologists today have two different AK procedure methods to choose from when reshaping the cornea to reduce astigmatism. The physician may use a corneal relaxation incision or a corneal wedge resection to alter the curvature of the cornea. Ophthalmologists will sometimes also perform AK correction at the time of cataract surgery to correct pre-existing astigmatism.

Problem: Many insurers, including Medicare, will only cover AK procedures if the patient’s astigmatism is iatrogenic (caused by prior surgery, such as cataract surgery or cornea transplant), says Janice Douglas, CPC, coder for the department of ophthalmology at the Medical College of Georgia in Augusta. Also, note that the CPT codes for AK procedures specify that the astigmatism must be surgically induced:

•  65772--Corneal relaxation incision for correction of surgically induced astigmatism

•  65775--Corneal wedge resection for correction of surgically induced astigmatism.

Medicare assigns 10.04 nonfacility RVUs to 65772, leading to $380.49 in reimbursement (unadjusted for geography) after multiplying by the 37.8975 conversion factor. The same formula yields $455.90 from the 12.03 facility RVUs assigned to 65775.

The ICD-9 codes many insurers will accept to prove the medical necessity of the procedure include:

•  367.20-367.22--Astigmatism

•  996.51--Mechanical complication due to corneal graft

•  V42.5--Organ or tissue replaced by transplant; cornea

•  V45.61--Cataract extraction status.

Warning: If the ophthalmologist plans to perform AK at the time of cataract surgery, you cannot code separately for it, since the National Correct Coding Initiative bundles 65772 and 65775 into cataract procedures 66982-66984, says Cindy Mundy, CCS-P, coder and abstractor for the UC Davis Medical Center.