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Thread: PRP vs Focal Laser

  1. #1
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    Default PRP vs Focal Laser

    To any ophthalmology coders,
    doctor does a PRP-L and a Focal-R for PDR and lists the spots, milliseconds, etc. for each procedure.... I thought these were both CPT 67228, but now I'm not so sure. Are they the same CPT but different laser protocols???? David, are you out there? Help!!!
    Badboy
    CPC,OCS

  2. #2

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    Quote Originally Posted by rhotonscott@yahoo.com View Post
    To any ophthalmology coders,
    doctor does a PRP-L and a Focal-R for PDR and lists the spots, milliseconds, etc. for each procedure.... I thought these were both CPT 67228, but now I'm not so sure. Are they the same CPT but different laser protocols???? David, are you out there? Help!!!
    I'm not David but...focal laser is 67210. Were they done on the same day?
    Remember your RT/LT on each and 79 mod on the 2nd one.

    Are you using same dx for both? Doesn't seem right. If you are, then you'll need 78 mod instead of 79.

  3. #3
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    Default

    Thanks-wrote your comments in my CPT book!!!
    Badboy
    CPC,OCS

  4. #4
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    Default

    What if a patient has a PRP 67228 and Focal 67210 both done on the same eye same date different diagnosis. Ex : 67228 RT 250.50 362.02 and 67210 RT 362.83

  5. #5

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    Quote Originally Posted by cpccoder2008 View Post
    What if a patient has a PRP 67228 and Focal 67210 both done on the same eye same date different diagnosis. Ex : 67228 RT 250.50 362.02 and 67210 RT 362.83
    If separate spots/location do a 59 mod on the lesser paying one.

  6. #6
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    Default Lasers in clinic

    I am always confused with billing lasers. They say you cannot bill within 90 global because they are performed in multiple sessions but does that mean per CPT code ?? Like if you have a patient who has a PRP on the RT then returns 4 weeks later and has a Focal on that same eye is that billable ?? What about vice versa, a Focal first then PRP later.. i attended a seminar and they said if a patient has a YAG Capsulotomy 66821 during global of cataract surgery 6698* you add -78..

  7. #7

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    Quote Originally Posted by cpccoder2008 View Post
    I am always confused with billing lasers. They say you cannot bill within 90 global because they are performed in multiple sessions but does that mean per CPT code ?? YES, Per CPT code Like if you have a patient who has a PRP on the RT then returns 4 weeks later and has a Focal on that same eye is that billable ??YES, with a modifier (78 or 79 depending on if related to reason for which you are in p/o period) What about vice versa, a Focal first then PRP later.. same thing, can bill i attended a seminar and they said if a patient has a YAG Capsulotomy 66821 during global of cataract surgery 6698* you add -78..
    Yes, the YAG IS related to the cataract. You should not have to do a YAG during the post op period though. If you do, be prepared with documentation to prove medical necessity.

    see my other red inserts within your post

  8. #8
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    Default

    Quote Originally Posted by cpccoder2008 View Post
    What if a patient has a PRP 67228 and Focal 67210 both done on the same eye same date different diagnosis. Ex : 67228 RT 250.50 362.02 and 67210 RT 362.83
    See VP cats response above:67228-RT,67210-79-RT(put the more expensive procedure first)
    Badboy
    CPC,OCS

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