Ophthalmology and Optometry Coding Alert

Retinal coders, take note: The latest version of Correct Coding Initiative (CCI) edits adds to the list of CPT codes you cannot report with certain retinal detachments.

Effective July 1, CCI places lens extraction codes 66920 (Removal of lens material; intracapsular), 66930 (... intracapsular, for dislocated lens) and 66940 (... extracapsular) into a Column 1/Column 2 edit with retinal detachment repair code 67108 (Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique).

Code 67108 is the Column 1 procedure in these edits, meaning that CCI views it as a comprehensive procedure that already includes the work described by 66920-66940. Lensectomy codes 66840-66852 (Removal of lens material ...) are already bundled with 67108, thanks to previous CCI edits.

Don't miss: Retinal detachment repair code 67113 (Repair of complex retinal detachment ...), introduced in CPT 2008, also includes lensectomy and lens extraction codes 66840-66940.

As of July 1, CCI considers cataract surgery codes 66982-66984 included in 67108. The cataract codes are also components of 67113. Last April's CCI deleted the bundles including 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) and 66986 (Exchange of intraocular lens) in 67113, however, and CCI does not bundle those codes into 67108. (For more information, see "Bundling Cataract Removal and Trabeculotomy? Not Anymore" in Ophthalmology Coding Alert Vol. 11, No. 5.)

CCI has marked all of these bundles with modifier indicator "1," which, as a rule, means that you can override the edits with modifier 59 (Distinct procedural service) in appropriate circumstances, says Vicky Varley O'Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis.

Because visual field tests are usually necessary for blepharoptosis patients to document how much the drooping eyelids are impairing vision, you may be startled to see a new bundle in CCI version 14.2 including 92081-92083 (Visual field examination, unilateral or bilateral, with interpretation and report) in 67901-67908 (Repair of blepharoptosis).

CCI marks these bundles with modifier indicator "0," meaning that you cannot report a 9208x code with a 6790x code under any circumstances.

Not so fast: Keep in mind that these edits only prevent you from reporting visual fields performed on the same day as blepharoptosis repair, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. Because most patients undergo the visual field testing before the surgery, you should have no problem reporting the tests separately.

"Most practices do the visual fields, and then the physician reviews the results and decides to schedule the repair. It doesn't usually all happen on the same date," Mac says.

Although Category III code 0186T (Suprachoroidal delivery of pharmacologic agent [does not include supply of medication]) is so new it hasn't made it into your CPT manual yet (look for it in CPT 2009), CCI has caught up with it with a host of edits. As of July 1, all of the "Posterior Segment" codes 67005-67255 include that new code, as well as 0124T (Conjunctival incision with posterior juxtascleral placement of pharmacological agent [does not include supply of medication]).

CCI 14.2 has also turned its attention to several conjunctivoplasty procedures, pairing them with procedures it considers mutually exclusive. Effective July 1, 68320 (Conjunctivoplasty; with conjunctival graft or extensive rearrangement) is mutually exclusive with:

• 68330 -- Repair of symblepharon; conjunctivoplasty, without graft

• 68340 -- ... division of symblepharon, with or without insertion of conformer or contact lens.

Code 68325 (Conjunctivoplasty; with buccal mucous membrane graft [includes obtaining graft]) is mutually exclusive with:

• 68320

• 68326 -- Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement

• 68330

• 68335 -- ... with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)

• 68340.

There's more: Other changes include:

• Code 68326 is mutually exclusive with 68320, 68330 and 68340.

• Code 68328 (Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft [includes obtaining graft]) is mutually exclusive with 68320, 68325, 68326, 68330, 68335 and 68340.

• Code 68330 is mutually exclusive with 68340.

• Code 68335 is mutually exclusive with 68320, 68326, 68330 and 68340.

Some of these edits are revisions of previous mutually exclusive bundles, switching the column 1 and column 2 procedures.

Example: Code 68320 has a longstanding mutually exclusive bundle with 68325, but previously 68320 was the column 1 code. Effective July 1, 68325 is the column 1 code, meaning that if you report the two codes together, carriers following CCI would only reimburse for 68325.

CCI 14.2 gives corneal transplant codes 65710-65755 (Keratoplasty) several new Column 1/Column 2 and mutually exclusive edits. The keratoplasty codes will include as components:

• 65400 -- Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

• 65410 -- Biopsy of cornea.

Codes 65710-65755 will also be mutually exclusive with:

• 65420 -- Excision or transposition of pterygium; without graft

• 65426 -- ... with graft

• 65435 -- Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)

• 65436 -- ... with application of chelating agent (e.g., EDTA)

• 65450 -- Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization

• 65772 -- Corneal relaxing incision for correction of surgically induced astigmatism

• 65775 -- Corneal wedge resection for correction of surgically induced astigmatism.

Watch for: As of July 1, cryotherapy code 66720 (Ciliary body destruction; cryotherapy) includes the following:

• 93000-93010 -- Electrocardiagram, routine ECG with at least 12 leads

• 93040-93042 -- Rhythm ECG, one to three leads

• 94770 -- Carbon dioxide, expired gas determination by infrared analyzer.

These bundles are all marked with modifier indicator "1," meaning you can unbundle them when appropriate.

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