Cpt code for LASIK eye surgery.

CPT LASIK: CPT code for LASIK eye surgery

LASIK (laser-assisted in situ keratomileusis) is a high-paying refractive procedure and is not covered by most insurance plans, including Medicare. In some instances, LASIK is considered a self-pay procedure, or it may be covered by insurance. There is no CPT code for lasik eye surgery.

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CPT code for lasik eye surgery

One of the challenges that patients and ophthalmologists face when billing for LASIK is that there is no specific CPT code for this procedure. CPT (Current Procedural Terminology) codes are standardized codes that describe medical services and procedures for billing purposes.

According to CPT convention, the appropriate code to use for LASIK is 66999 (unlisted procedure, anterior segment of eye), unless the payer gives instructions in writing to use a different code. However, some payers may require or prefer a different code, such as 65760 (keratomileusis), which is technically incorrect but may be accepted by some payers (1)Therefore, it is important to check with the payer before performing LASIK to verify their coding and reimbursement policies.

Another variation of LASIK that may affect coding and billing is endoscopic cyclophotocoagulation (ECP), which is a procedure that uses a laser to destroy part of the ciliary body (the tissue that produces aqueous humor) to lower intraocular pressure (IOP) and treat glaucoma. ECP can be performed alone or in combination with cataract surgery or LASIK. If ECP is performed alone, the CPT code is 66711 (ciliary body destruction; cyclophotocoagulation, endoscopic; without concomitant removal of crystalline lens)3. If ECP is performed with cataract surgery, the CPT code is 66982 (extracapsular cataract removal with insertion of intraocular lens prosthesis; complex) or 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis; without endoscopic cyclophotocoagulation), depending on the complexity of the case.

If ECP is performed with LASIK, the CPT code is 66988 (extracapsular cataract removal with insertion of intraocular lens prosthesis; with endoscopic cyclophotocoagulation). However, this code may not be recognized by some payers as well.

If one company requires you to bill 65760 for LASIK it does not mean that all companies require you to bill the  same code. Some companies that cover this procedure may want you to code correctly with the unlisted-procedure code. And do not assume that because one company has a certain health insurance plan that covers LASIK that all plans offered by that company cover the procedure. For example U.S. Healthcare does not as a rule pay for LASIK but covers it for Merck employees.

Unlisted-Procedure Codes: A Viable Solution

LASIK eye surgery, a popular vision correction procedure, presents a unique coding challenge due to the absence of a dedicated CPT code. To overcome this hurdle, medical practitioners may turn to unlisted-procedure codes such as 66999 or 65760. However, it’s crucial to understand that these codes are not specific to LASIK but serve as placeholders for procedures lacking dedicated codes.

Unlisted-procedure codes may be employed effectively by recording them in the code file with a clear description of the LASIK procedure attached. This practice ensures that it is evident the procedure performed was, indeed, LASIK. While the code itself may not be LASIK-specific, the attached description eliminates ambiguity.

CPT LASIK

Harnessing the Power of Dummy Codes: Cpt code for lasik eye surgery

Another creative approach for tracking LASIK procedures is the use of dummy codes. Some electronic health record systems permit the use of codes with up to seven digits. In this context, healthcare providers can use codes like 65760 or 66999 and incorporate a dummy modifier specifically designed to signify LASIK. This empowers practices to maintain a structured record of LASIK surgeries within their coding system.

Managing Insurance Coverage

LASIK surgery can be elective, and insurance coverage for this procedure varies widely. Many patients opt to pay for LASIK out of pocket. In such cases, it’s essential to implement safeguards in your practice’s computer systems and patient charts to prevent accidental insurance claims, especially when insurance policies do not cover LASIK.

One effective strategy is to flag patients who are undergoing LASIK in your computer program and patient charts. This flag acts as a visual reminder to the healthcare team that the patient is responsible for covering the cost of the procedure, and insurance claims should not be submitted.

Flexible Use of Dummy Codes and Modifiers

In the complex landscape of healthcare coding, flexibility is key. Practices often adapt to various scenarios, using dummy codes or unlisted-procedure codes based on the patient’s insurance coverage. This adaptability can be further enhanced by the use of dummy modifiers.

Providers can employ dummy modifiers on both the 65760 and 66999 codes, differentiating between insurance-covered and patient-pay scenarios. For instance, one dummy modifier may indicate insurance coverage, while another signifies that the patient is responsible for payment. This approach streamlines the tracking process by tying coverage information directly to the modifier and code combination.

Conclusion

In the absence of a dedicated CPT code for LASIK eye surgery, healthcare professionals must exercise diligence and creativity in their coding practices. Utilizing unlisted-procedure codes, dummy codes, and strategic modifiers enables accurate tracking and documentation of LASIK procedures. By implementing these techniques, medical practices can maintain clarity in their records, streamline billing processes, and ensure that patients receive the appropriate billing information for their LASIK surgeries. Accurate and comprehensive coding is not only a compliance necessity but also a testament to a practice’s commitment to precision in healthcare delivery.

Reference: (1) –https://www.aapc.com/codes/coding-newsletters/my-ophthalmology-coding-alert/

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