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Miscoding retinal laser surgery
Retina and choroid laser treatments are reported using different CPT codes.
A patient comes in for re-evaluation of previously diagnosed age-related macular degeneration. Examination reveals new onset of choroidal neovascularization requiring laser treatment for the abnormal blood vessels. She consents and laser treatment is performed.
The practice’s laser operative report form includes a description of several retinal laser therapies. You note that 89 laser spots were applied and check off the description for destruction of localized lesion of retina, photocoagulation. The office submits a claim for photocoagulation of localized lesion of retina (67210).
The patient returns for follow-up 1 month later, and additional laser treatment is necessary. This operative report indicates that destruction of localized lesion of choroid, photocoagulation, was performed. The office submits a claim for photocoagulation of localized lesion of choroid (67220).
Both claims are paid.
Were these services billed and paid appropriately?
No. When discussing treatments with patients, the retina and choroid are sometimes described as one part of the eye; they are not. The choroid (the layer of blood vessels beneath the sclera) feeds the retina. Treatment to the choroid is specific and distinct. Code 67220 was added to Current Procedural Terminology in 1999 to distinguish this treatment from code 67210, focal laser of retina. Prior to 1999, all claims were filed with 67210.
The correct coding for the initial date of service is 67220. The CPT book contains the phrase “one or more sessions” as part of the definition for this and a number of other laser procedures. When performed in stages, only the initial procedure is reimbursed. Thus the session performed 1 month later was ineligible for reimbursement. Accurate documentation of the service provided enables accurate claim filing.