Guidelines for Laser Procedures Billing

1
(No Transcript)
2
Guidelines for Laser Procedures Billing
Some states now allow optometrists to perform
certain laser surgical procedures. Till the end
of the year 2022, almost 10 states approved laser
procedures. In this article, we shared guidelines
for laser procedures billing including procedures
Argon Laser Trabeculoplasty (ALT), Selective
Laser Trabeculoplasty (SLT), YAG Capsulotomy, and
Laser Peripheral Iridotomy (LPI). With some
exceptions, most states have added these laser
procedures to the services optometrists may
provide for their patients. Any optometrist
providing these services must know how to
properly document medical necessity to show that
it is reasonable and appropriate for their
patients to undergo these procedures. Likewise,
it is vital for optometrists to know how to
properly code and bill for the procedures
mentioned above so that they are paid properly
and do not deal with denied claims. Guidelines
for Laser Procedures Billing It may be possible
to perform SLT/ALT, YAG Capsulotomy, and LPI
bilaterally on the same date of service, the
Medicare Medically Unlikely Edits (MUEs)
generally limit them to one procedure per date of
service. If both eyes are done on the same day,
the claim will most likely be denied. Note that,
if a patient is seen for an office visit to
determine whether a laser procedure is
appropriate, and then the procedure is done on
the same day, the office visit fee will be
bundled into the laser procedure fee. This is not
considered separately billable in most cases.
3
Guidelines for Laser Procedures Billing

• Billing for SLT/ALT
• The procedure (CPT) code applicable for Argon
  Laser Trabeculoplasty (ALT) Selective Laser
  Trabeculoplasty (SLT) is 65855. The global period
  for SLT/ALT is 10 days and in the year 2022
  Medicare pays (for non-facility) 246.97 for
  these procedures.
• CPT code 65855 is from the Incision Procedures
  on the Anterior Chamber of the Eye code category
  and its description is, trabeculoplasty by laser
  surgery, 1 or more sessions (defined treatment
  series).
• In the year 2016, CPT code 65855 was modified to
  align with an assigned 10-day global period and
  that only one laser treatment is typical during
  this time period. Note that CPT code 65855 should
  not be submitted for payment in conjunction with
  codes 65850, 65865, 65870, or 65875 when
  performed in the same operative session.
• After the decision for laser surgery has been
  made, the chart documentation should include
  Discussion of the indications for surgery the
  Determination that medical therapy failed or was
  contraindicated the Patients informed consent
  the Laser operative report and the Physicians
  signature.
• When there is a separate and identifiable reason
  for the visit, modifier 25 should be appended to
  the visit code. Modifier 25 indicates that the
  patients condition has required an additional
  E/M service beyond the usual pre-operative care
  provided for the procedure or service.

4
Guidelines for Laser Procedures Billing

• For SLT/ALT, the three major criteria used to
  document medical necessity are the following
• Utilizing SLT/ALT as the primary treatment for
  open-angle glaucoma
• Primary open-angle glaucoma (POAG) has been
  unresponsive to medications
• POAG with normal intraocular pressure (IOP) with
  evidence of continued optic nerve damage
• It is important for the provider to document the
  symptoms, IOP, status of the anterior chamber
  angles, and optic nerve head assessment in the
  medical record.
• Billing for YAG Capsulotomy
• The procedure (CPT) code applicable for YAG
  Capsulotomy is 66821. The global period for YAG
  Capsulotomy is 90 days and in year
  2022 Medicare pays (for non-facility) 335.47
  for this procedure.
• CPT code 66821 is from the Incision Procedures
  on the Lens of the Eye code category and its
  description is, discission of secondary
  membranous cataract (opacified posterior lens
  capsule and/or anterior hyaloid) laser surgery
  (e.g., YAG laser) (1 or more stages).
• You have to use modifier -50 if the procedure is
  done bilaterally, or use modifier -LT/-RT if
  performed on one eye only. You have to report
  modifier -78 if the procedure is performed within
  90 days of cataract surgery.

5
Guidelines for Laser Procedures Billing

• When a series of procedures is planned for the
  removal of a posterior dense fibrotic capsule, it
  will be covered as a single procedure.
• For YAG Capsulotomy, the four main criteria that
  may be used to document medical necessity are
• Visual acuity (VA) decreased or glare affected to
  20/30 or less
• Symptoms of decreased contrast sensitivity
• The amount of posterior capsule opacification
• Other possible causes of decreased VA after
  cataract surgery have been ruled out
• It is important that the provider properly
  documents the criteria used for the medical
  necessity of coverage or justification for doing
  a YAG procedure during the 90-day global period.
• Billing for Laser Peripheral Iridotomy (LPI)
• The procedure (CPT) code applicable for Laser
  Peripheral Iridotomy (LPI) is 66761. The global
  period for LPI is 10 days and in the year 2022
  Medicare pays (for non-facility) 301.72 for
  this procedure.
• CPT code 66761 is from the Destruction
  Procedures on the Iris, Ciliary Body of the Eye
  code category and its description is,
  iridotomy/iridectomy by laser surgery (e.g., for
  glaucoma) (per session).

6
Guidelines for Laser Procedures Billing

• For LPI, the four major indications for the
  procedure are
• Acute angle closure glaucoma
• Chronic angle closure glaucoma
• The fellow eye has had an acute angle closure
• Gonioscopy shows narrow/occludable angles
• Showing medical necessity for LPI would involve
  documenting the patient's symptoms, IOP, and
  anterior chamber angle status with gonioscopy.
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing complete
  billing and coding services. We shared guidelines
  for laser procedures billing for provider
  education purposes, you are advised to refer
  following links for a detailed understanding. If
  you need assistance with optometry billing and
  coding services, call us at 888-357-3226 or
  email us at info_at_medicalbillersandcoders.com.