Practice Managment Considerations for Astigmatic Keratotomy – Donna McCune, COE, CCS-P
Technological advances offering patients improved surgical outcomes excite and challenge ophthalmologists. To provide patients with reduced reliance on spectacles astigmatic keratotomy (AK) is sometimes performed for existing astigmatism. Third party payer coverage of AK depends on the cause of the astigmatism. Most payers cover AK treatment for iatrogenic astigmatism, but consider treatment of existing astigmatism elective refractive surgery. Treatment of iatrogenic astigmatism is coded with either 65772 (corneal relaxing incision for correction of surgically induced astigmatism) or 65775 (corneal wedge resection for correction of surgically induced astigmatism). There is no unique CPT code to describe AK for existing astigmatism. Use CPT 66999 (unlisted procedure, anterior segment of eye) to code the procedure. As a practical matter, due to similarities in surgical technique, you might use the value assigned to 65772 by Medicare to establish a professional fee. Prior to the procedure, the surgeon should educate the patient on the risks, benefits, and alternatives. The consent for AK may be separate or a second item listed on the cataract surgery consent form. A second discussion regarding reimbursement informs the patient that the procedure is non-covered and the patient is financially responsible. The patient should sign a waiver informing. Payment for the non-covered procedure may be collected in advance of the surgery. Developing reasonable fees and practice management protocols, educating staff and patients, and utilizing waiver forms improve your chances for success.
Ocular Surgery News; January 2005.