Ophthalmology and Optometry Coding Alert

Indicators of -1- offer you an out for exceptions -- if you meet the requirements Good news: The ophthalmology codes you use escaped major overhaul in the latest round of Correct Coding Initiative (CCI) edits. Version 13.2, which took effect in July, adds the following new bundles that you-ll need to take into account for your ophthalmology coding: - CCI 13.2 bundles column 2 code 67515 (Injection of medication or other substance into Tenon's capsule) with column 1 codes 67036 (Vitrectomy, mechanical, pars plana approach), 67039 (Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation) and 67040 (Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation). - You-ll also find that the latest CCI bundles 68200 (Subconjunctival injection) into both 67036 (Vitrectomy, mechanical, pars plana approach) and 67039 (Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation). - Finally, CCI now bundles 68810 (Probing of nasolacrimal duct, with or without irrigation) and 68811 (Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia) with 68761 (Closure of the lacrimal punctum; by plug, each). No surprises: These edits, "particularly the 68761 with 68810 and 68811, make sense," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. "I don't necessarily agree with the edit but can see why CCI bundled the codes. An ophthalmologist may perform the probing prior to the closure; that is, one may lead to the other." Helpful hint: All of the new ophthalmology bundles have a modifier indicator of "1." This means you can override the edits by reporting both codes with a modifier, such as modifier 59 (Distinct procedural service), appended to the bundled code, and expect to be paid for both under the proper clinical circumstances.