Full Answer
The authors reviewed the charts of 10 patients who were treated for phacomorphic glaucoma, by first undergoing neodymium:YAG (Nd:YAG) laser iridotomy. In all patients, the acute angle-closure glaucoma attack could be reversed or prevented by the iridotomy, before subsequent cataract extraction.
Aetna considers Nd:YAG laser peripheral iridotomy medically necessary prior to intraocular lens insertion into the anterior chamber to avoid post-operative iris bombe or pupil block.
A Medscape review on “Glaucoma, angle closure, chronic treatment & management” (Tham, 2012) stated that “Laser iridotomy is indicated for all stages of chronic angle-closure glaucoma (CACG). Laser iridotomy involves the creation of a hole in the peripheral iris by laser.
Laser iridotomy and surgical iridectomy are not effective. 5. Systemic drugs with effects on the iridocorneal angle
CPT66761Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session) [when specified as laser peripheral iridotomy]ICD-10 Procedure085C3ZZDestruction of right iris, percutaneous approach085D3ZZDestruction of left iris, percutaneous approach6 more rows
Questions about Medicare rules for YAG laser capsulotomy (CPT 66821) still come up. Here are some that practices ask about the most.
Background. Laser peripheral iridotomy (LPI) is the preferred procedure for treating angle-closure glaucoma caused by relative or absolute pupillary block. LPI eliminates pupillary block by allowing the aqueous to pass directly from the posterior chamber into the anterior chamber, bypassing the pupil.
The YAG laser is the laser used to clear the frosting from the back surface of an intraocular lens. YAG laser treatment is painless and is completed from outside the eye in a few minutes.
If the doctor performs a YAG in the postop period, first we bill it to Medicare with the -79 modifier, she says. Then we get the denial back. And then we send it in again with a medical necessity note from the doctor.
Documentation Requirements Documentation such as the patient's medical record should demonstrate very clearly why Yag laser capsulotomy was performed. This should include the results of a visual acuity test and/or a glare test.
A YAG laser iridotomy is a treatment for anatomically narrow angles, a condition that affects your eye's ability to drain fluid. Similar to inflating a basketball with too much air, lack of drainage can result in increased eye pressure. Having anatomically narrow angles puts you at risk for acute closed-angle glaucoma.
Laser iridotomy is a treatment for narrow-angle glaucoma. In laser iridotomy, a small hole is placed in the iris to create a hole for fluid to drain from the back of the eye to the front of the eye.
Types of Lasers for LPI Iridotomy can be accomplished using the photodisruptive Q-switched Nd:YAG laser (Nd:YAG) or the photo-thermal Nd:YAG-KTP 532 nm (which is still often called Argon laser) and solid-state lasers.
Nd:YAG lasers are used in manufacturing for engraving, etching, or marking a variety of metals and plastics, or for metal surface enhancement processes like laser peening. They are extensively used in manufacturing for cutting and welding steel, semiconductors and various alloys.
Where is ND: YAG most commonly used? Explanation: ND: YAG is most commonly used for cosmetic energy because it has the property of maximum energy absorption by the target (hair or lesion) with minimum absorption by the surrounding skin structures. Explanation: Laser has a large bandwidth.
What is YAG laser capsulotomy? YAG laser capsulotomy is surgery to help you see clearly after cataract surgery. You may need this surgery because months or years after cataract surgery, your vision may get fuzzy again. This happens when a membrane in your eye, called the posterior capsule, becomes cloudy.
Laser peripheral iridotomy (also described as ‘laser iridotomy’ or simply termed 'iridotomy') is a medical procedure which uses a laser device to create a hole in the iris, thereby allowing aqueous humor to traverse directly from the posterior to the anterior chamber and, consequently, relieve a pupillary block.
Closure of the iridotomy has been reported to occur at a rate between 1% at 2 weeks to 20% within the first 6 months after the procedure, but the vast majority of iridotomies may remain patent years after the procedure. This may occur due to accumulation of debris and pigment granules, although complete closure of the iridotomy is unusual with ND:Yag lasers. Repeat LPI can be performed at the same site immediately after the first procedure, a few hours later if debris impede the observation of the iridotomy or creating an iridotomy at another site.
Laser peripheral iridotomy (LPI) is indicated to prevent or overcome a suspected relative pupillary block by creating an alternative pathway for aqueous flow. Mainly used for patients in the primary angle closure spectrum, it can also be useful in secondary angle closure glaucoma and in the management of other types of glaucoma with associated pupillary block. The iridocorneal angle should be, in all cases, carefully examined after LPI to rule out other mechanisms of a closed angle requiring treatment. The indications for LPI are summarized in table 1.
If IOP remains uncontrolled after LPI, a filtering surgery should be considered as the next step.
LPI has been shown in trials to prevent recurrent attacks of acute angle closure, with an effectiveness and safety equal to that of surgical iridectomy, and with better acceptability to patients. Good effectiveness in preventing acute attacks in fellow eyes has also been reported. Nonetheless, isolated reports do exist of eyes experiencing a recurrent acute attack after LPI. In AAC, laser iridotomy relieves the attack in most cases. Superior outcomes have been reported in Caucasian eyes than in Asian eyes. In AAC attacks, significant amount of PAS, a higher presenting IOP, longer attack duration, poor initial response to therapy (<30% IOP) and a larger C/D ratio, have been associated with inadequate long-term IOP control after LPI. These findings are consistent with a more severe disease affecting the ITC and the trabecular meshwork.
Iridotomy is strongly recommended in eyes with PAC or PACG. PAC patients may have elevated IOP from chronic compromise of aqueous outflow. Chronic angle-closure glaucoma features permanent synechial closure of any extent as confirmed by indentation gonioscopy. Medical treatment alone is contraindicated as all patients require relief of pupil block by iridotomy, iridectomy or lens extraction. If the peripheral anterior synechiae occupy less than 50% of the circumference, iridectomy or iridotomy may suffice. Since complications of laser iridotomy are uncommon, its use as the initial procedure is justified in practically every case, as soon as the corneal transparency allows the LPI to be performed. If IOP remains uncontrolled after LPI, a filtering surgery should be considered as the next step. However, In asymptomatic (“chronic”) angle-closure, a high presenting pressure (>35 mmHg), more than 6-clock hours of peripheral anterior synechiae and/or established glaucomatous optic neuropathy are signs that the angle-closure will not respond fully to an LPI, and that surgical treatment may be needed to reach the IOP goal.
Although it is well absorbed by iris pigment, argon laser (and Nd:YAG-KTP laser, which is often referred to as "argon laser") iridotomy alone was associated with some complications and relatively high failure and subsequent closure rates.