Wiki 66984 with 65772

[Captain74]

I have a Ophthalmologist who is doing cataract surgery (66984) and at the same time is doing a corneal relaxing incision (65772) because his 66984 will cause an astigmatism and he doesn't want to inconvenience the patient by having them come back at a later time to have that fixed.

The CPT book for 65772 reads "corneal relaxing incision for correction of surgically induced astigmatism" and doesn't state that is can't be billed with the 66984.

I have referenced the Coders Desk Reference (CDR) and it the description it states "when a previous surgery results in astigmatism, the physician at a later date returns the patient to the operating room to correct the problem," but my provider doesn't like that definition. He thinks if the time factor was important that it would have been listed in the CPT code description. I tried to explain that hte CDR is designed to provide additional information to individuals who don't have a medical background (surgeon, etc) so they better understand the codes, but that wasn't good enough.

I have used EncoderPro and Craneware to check if there is an edit or if a modifier is allowed and it does allow a modifier. I have also checked the CCI edits on Medicare's website and there doesn't seem to be an issue there either.

So, can these codes be billed together on the same day? How about the day after? If anyone has concrete evidence, I would appreciate a link to the information. I have read posting that it won't be reimbursed, but with this provider, I better have some hard evidence to show him. I wish there was a way to test codes in the Medicare system to see if they would payable or not so he could see that.

Any help is apprecaited. PLEASE!!!

Thanks

Cory

 

[smarcolina]

I have billed for an Ophthalmologist for many years and have never been paid for an L.R.I. by an insurance company for astigmatism that was caused by a cataract operation. It has been my experience that the only time an insurance company will consider this procedure for payment is when the patient has had a corneal transplant performed and astigmatism is a direct cause of the operation. We charge the patient out of pocket for this procedure and it is coded as 66999 not 65772. I hope this helps.
Sharon