DOES YOUR OPHTHALMOLOGY PRACTICE BILL FOR YAG’S? BELOW ARE TIPS TO GET YOUR CLAIMS PAID TIMELY.
#1 Payment is per eye. Use modifier -50 if the procedure is done bilaterally. Use modifiers -RT or -LT if the procedure was performed on only one eye. Use modifier -78 if the procedure was performed within 90 days of cataract surgery (on the same eye). Remember when using modifier -78, the 90 day global period does not start over. Use modifier -79 if the procedure was performed during a global period of an unrelated procedure.
#2 Documentation in the patient’s medical record should clearly show why the YAG was performed. This includes the results from a visual acuity test and/or glare test. Not all payers have a visual acuity requirement, so make sure you know the requirements for the payer you’re billing.
#3 Always remember to obtain prior authorization for the health plans that require it.
#4 Typical diagnosis codes showing medical necessity include H26.411-H26.413, H26.491-H26.493, T85.21XA, T85.22XA, and T85.29XA.
#5 CPT 66821 has a global period of 90 days. Don’t forget to use appropriate modifiers, as insurance carriers will deny claims with incorrect coding.