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.

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 Patient’s informed consent; the Laser operative report; and the Physician’s 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 patient’s condition has required an additional E/M service beyond the usual pre-operative care provided for the procedure or service.
• 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.
• 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).
• 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@medicalbillersandcoders.com.

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Published By - Medical Billers and Coders
Published Date - Jan-13-2023 Back