Medicare Compliance & Reimbursement

Prepare to specify your doctor's approach to retina surgery

Heads up: If your ophthalmologist performs retina surgeries, prepare for a new wave of coding rules come January. CPT 2008 will offer you approach-specific codes for some common procedures, and HCPCS 2008 brings a J code for Lucentis.

CPT 2008 will delete 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) and add three new codes for vitrectomy procedures. The new codes let you specify the method your physician uses to remove the retinal membrane.

You'll have to get used to the different types of vitrectomy to be able to use the new codes (67041-67043), says Regan Bode, product manager for Custom Coding Books in Seattle and Eyecoding.net founder.

The descriptors for the three new codes all describe a mechanical vitrectomy but also include specific information about the rest of the procedure. For example, you'll use 67041 when the doctor removes the preretinal cellular membrane, or 67042 if the doctor removes the internal limiting membrane of the retina.

"The new codes seem to cover all the scenarios under which we would have used 67038 and are good distinctions," says Karen Bartrom, coder with Vitreo-Retinal Consultants in Indianapolis.

Tip: Coders will have to rely on solid physician documentation to be able to choose the appropriate code based on the surgical methodology. Your updated 2008 CPT manual and the Correct Coding Initiative (CCI) should list the codes that you won't be able to report along with these codes.

Anticipate New Retinal Detachment Code

You can also look forward to a new code for complex retinal detachment (67113). The new retinal detachment code "classifies repair of a complex retinal detachment with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens," Bode explains.

More new codes: CPT 2008 also adds new codes for balloon catheter tear duct dilation (68816) and retinopathy treatment in preterm infants (67729).

And CPT 2008 changes the descriptor for extensive or progressive retinopathy treatment code 67228. Starting in January, you'll use this code for one or more sessions, not just a single session. The descriptor also deletes the phrase "laser or xenon arc."

HCPCS heads up: Starting in January, you'll have a J code specifically for Lucentis, sources say. Gone will be the days of using unlisted codes J3490 (Unclassified drugs) or J3590 (Unclassified biologics) for the drug supply.