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Ophthalmology Coding Alert

Reader Question:

Go Beyond Diagnoses for YAG Laser Denial

Question: Our ophthalmologist used a YAG laser (66821) for a diagnosis of “vitreous strands” and billed H43.311, but I don’t see that listed as an acceptable diagnosis for 66821. Is there an appropriate ICD-10 code? Subscriber

Answer: The ICD-10 code (H43.311, Vitreous membranes and strands, right eye) is not the problem here — it’s the CPT® code. In this case, you should report 67031 (Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery [1 or more stages]), even although it does not specifically mention the YAG (yttrium aluminum garnet) laser.

Code 66821 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]) does specify the tool your ophthalmologist used, but not the work he did. Report 66821 only for after-cataract treatments with the YAG laser