Ophthalmology and Optometry Coding Alert

Medicare lifts the weight from coders' shoulders with a glittering list of ASC procedures















In June, we gave you the good news that ASCs can start coding 66711 to report endoscopic photocoagulation in July. The rest of the news is even better: Starting July 5, there are 10 additional ophthalmological codes that coders in ambulatory surgery centers can begin reporting - including gold weight insertions to correct lagophthalmos.

Added to Medicare's list of approved procedures for ASCs are:

The appearance of 67912 on the list is especially welcome news to Joy Maddox, coder for the Eye Center of North Florida, an ASC in Panama City.  "We're really happy about that," she says.  "We've done thoses in the past, and, of course, we just had to eat out ASC charges."

Criterion: For Medicare to add a procedure to the ASC approved code list, it must have data indicating that physicians perform the procedure in the office less than 50 percent of the time.  That criterion kept a number of codes off the list and brought about lobbying from the American Academy of Ophthalmology.

CMS considered a variety of laser procedures for addition to the ASC-approved list, including trabeculoplasty (65855, Trabeculoplasty by laser surgery, one or more sessions), retinal detachment repairs (67105, Repair of retinal detachment, one or more sessions; photocoagulation, with or without draining of subretinal fluid; 67110, Repair of retinal detachment; by injection of air or other gas; 67145, Prophylaxis of retinal detachment without drainage, one or more sessions; photocoagulation) and lesion destruction (67210, Destruction of localized lesion of retina, one or more sessions; photocoagulation; 67220, Destruction of localized lesion of choroid; photocoagulation, one or more sessions; 67221,...photodynamic therapy).  However, it found that all of these suggested procedures were performed primarily in the physician's office, so they did not make it to the list.  But because endoscopic cyclophotocoagulation does occur in the office less than 50 percent of the time, CMS approved and added the code to the ASC list.

If a procedure an ophthalmologist performs is not the ASc-approved list, there's simply no way to code for it and be reimbursed, Maddox says.

Note: To view the complete interim final rule, including a list of all ASC-approved codes, visit http://www.cms.hhs.gov/suppliers/asc/1478_42805.pdf.