Billing and Coding: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

Medicare covers capsulotomy (YAG or discission) for posterior capsular opacification when it causes documented significant visual impairment; capsulotomy within three months of cataract surgery is generally not indicated unless specific documented risk factors or complications exist. Claims require valid ICD-10-CM diagnosis codes, appropriate signed documentation (including ABN/CMS-R-131 when applicable), and payment is limited to once per eye per patient per 90-day global period; coding must comply with NCCI/OPPS rules and ABN modifier guidance.

"Posterior capsular opacification (ACO/PCO) after cataract surgery causing significant visual debility is an indication for capsulotomy (YAG laser or discission)."

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