To the Editor:
I read with concern your latest article on “Reimbursement Issues with Lasering Floaters” in the October 2013 issue. While the reimbursement issues may be accurate, the practice of lasering floaters is typically not practiced and is considered reckless by vitreoretinal surgeons at any respected institution that I am aware of. I have personally seen patients lasered for “floaters” who had diffuse macular laser scars that narrowly missed the fovea. Further, to state that surgical treatment “is the exception and not the rule” for debilitating vitreous opacities is completely untrue, again, according to any major training institution to which I have ever been exposed.

To publish this article may influence those with less experience (i.e., non-vitreoretinal surgeons) to consider this method of treatment that, again, is considered unsafe by most retinal specialists and largely unproven. Readers may best be served by articles on reimbursement for procedures that are less controversial and more routinely practiced.

Leon Charkoudian, MD
Wilmington, N.C.

Author response:
Thank you for your letter expressing concerns about my recent Medicare Q&A column. The purpose of this column is to present coding and reimbursement issues and not state opinions regarding the service itself. We do not assert to physicians how to care for patients. It would not be appropriate for us to do so. The article does state that this procedure is rare and that little data exists to support the success of the procedure at this time. We worked hard to present the information in a balanced manner appreciating the varied opinions regarding this treatment.

The following resources were used to develop this information:
    1. Ocular Surgery News, YAG Laser offers safe option for floaters, March 15, 2007.
    2. Delaney YM, Oyinloye A, Benjamin L. Nd: YAG vitreolysis and pars plana vitrectomy: Surgical treatment for vitreous floaters. Eye 2002;16:21-26.
    3. Tsai WF, Chen YC, Su CY. Treatment of vitreous floaters with neodymium YAG laser. Br J Ophthalmol 1993;77:485-488.
    4. Toczolowski J, Katski W. Use of Nd:YAG laser in treatment of vitreous floaters. Klinika Oczna 1998;100:155-157.
    5. Karickhoff J. Laser Treatment of Eye Floaters. Washington Medical Publishing LLC. 2005.
    6. Aetna. Clinical policy bulletin: YAG laser in ophthalmology: Selected indications. Number: 0354. Policy last reviewed on 07/17/2012.
    7. Blue Cross/Blue Shield of Florida, Medical Coverage Guidelines: Laser Vitreolysis, eff 11/15/09, rev 10/15/12.

We hope you will consider the article as an educational piece on coding and reimbursement and not as an endorsement for this procedure.

Donna M. McCune, CCS-P, COE, CPMA,
Vice President, Corcoran Consulting Group.