Ophthalmology and Optometry Coding Alert

Good news, ophthalmology coders: The next version of Correct Coding Initiative edits will not add any new bundles to your coding burden. In fact, CCI version 14.1 eliminates some bundles that may have been troublesome for you.

Effective April 1, CCI deletes the bundle pairing 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) with 65850 (Trabeculotomy ab externo). You may now report the two services together for the same patient on the same day, when the ophthalmologist performs them both.

Ophthalmologists sometimes combine cataract removal with trabeculotomy for patients with both cataracts and glaucoma.

Key: On the other hand, CCI 14.1 does not free you to report 65850 with complex cataract removal code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage).

Code 65850 remains bundled into 66982 with a "1" modifier indicator, which means you may report the two codes separately under the appropriate circumstances (for example, different eye, separate surgical session, etc.), says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

(For more information on complex cataract procedures, see "When Is Cataract Removal 'Complex'?" on page 35.)

Don't miss: CCI also still bundles 65850 with the following:

• 65855 -- Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)

• 66172 -- Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

• 66711 -- Ciliary body destruction; cyclophotocoagulation, endoscopic.

CCI 14.1 also deletes a bundle that affected the new retinal repair code introduced in CPT 2008 (67113, Repair of complex retinal detachment [e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees], 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).

As of April 1, CCI will no longer bundle 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) or 66986 (Exchange of intraocular lens) with 67113.

CPT established 67113 to "report repair of complex retinal detachment that involves a vitrectomy with the removal of a neovascular membrane from the subretinal space," according to CPT Changes 2008: An Insider's View. Coders welcomed the addition, says Katie Stillman, coding specialist for EYE Q Vision in Fresno, Calif. -- previously, coders could not always bill complex retinal detachment treatments to get the fullest reimbursement.

Not so fast: Several 67113 bundles, introduced in January by CCI 14.0, remain in effect. CCI still bundles more than 60 procedures -- including lens removal (66830-66940), cataract removal (66982-66984) and lesion destruction (67208-67221) -- with 67113, leaving you unable to report them separately without a modifier.

Online resource: On April 1, you can download the complete set of CCI edits from http://www.cms.hhs.gov/NationalCorrectCodInitEd.

Note: For more about CCI edits affecting 67113, read "Incorporate CCI Edits Into New Retinal Coding -- or Face a Slew of Denials" in Ophthalmology Coding Alert Vol. 11, No. 3.