Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | S-49 |
Topic: | Eye Procedures Done in Stages or Sessions |
Effective Date: | August 1, 2005 |
Issued Date: | September 10, 2007 |
Date Last Reviewed: | 06/2005 |
Indications and Limitations of Coverage
The procedures listed below are used to treat conditions involving the eye by various means, e.g., diathermy, cryotherapy, laser, etc., whether performed in one or more stages or sessions. The code appropriate to the method of treatment should be reported and reimbursed only once regardless of the number of sessions required to successfully complete the procedure. 65855 - (Trabeculoplasty)66761 - (Iridotomy) 66762 - (Iridoplasty) 66821 - (Discission of secondary membranous cataract by laser) 66840 - (Removal of lens material) 67101-67112 - (Repair of retinal detachment) 67141-67145 - (Prophylaxis of retinal detachment) 67208-67218 - (Destruction of localized lesion of retina) 67220-67225 - (Destruction of localized lesion of choroid) 67227-67228 - (Destruction of progressive retinopathy) The procedure codes listed on this bulletin are all considered staged procedures if the same exact code is reported by the same provider within the postoperative period. In addition, codes 67141-67228 are considered staged procedures when reported within the postoperative period of procedure codes 67101-67112, 67141-67208, 67218-67228. In this instance, no additional payment should be made beyond that already allowed for the initial procedure. Services performed on the other eye are not considered part of the original surgery and are eligible for payment.
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65855 | 66761 | 66762 | 66821 | 66840 | 67101 |
67105 | 67107 | 67108 | 67110 | 67112 | 67141 |
67145 | 67208 | 67210 | 67218 | 67220 | 67221 |
67225 | 67227 | 67228 |
[Version 001 of S-49] |