Ophthalmology and Optometry Coding Alert

Also: Despite new codes, eye exams are still bundled into critical care.

If your ophthalmic surgeons are performing the relatively new endothelial keratoplasty (EK) procedures for corneal transplants, watch out. There are some restrictions on what other codes you can report along with 65756 (Keratoplasty [corneal transplant]; endothelial).

Every quarter, the Correct Coding Initiative publishes a list of code pairs ("bundles") that coders should not report together for the same patient on the same date of service. There are 23 codes you should not be reporting along with 65756, according to CCI Version 15.0, which became effective in January. CCI bundles many injection and infusion procedures as components of EK, including 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]).

Code 65756 now also includes corneal topography code 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report).

"Physicians typically will perform corneal topography as part of the pre-operative testing for EK surgery, and again following the surgery at approximately 6, 12, and 24 months," explains Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. But the bundling edits are for services performed on the same calendar date and usually, ophthalmologists perform the corneal topography on a different date of service than the actual EK surgery. "Therefore, there should be no problem with submitting these services and getting reimbursed," Mac says.

New Edits May Look Familiar

The new bundles also include:

 • Vascular injection procedures 36000 and 36410
 • Transcatheter therapy code 37202
 • Bladder catheter codes 51701-51703
 • Spinal injection codes 62318 and 62319
 • Nerve block injection codes 64402, 64415-64417, 64450, 64470, and 64475
 • Operating microscope code +69990
 • Hydration, infusion, and injection codes 96360, 96365, 96372, 96374, and 96375.

CCI 15.0 bundled those hydration, infusion, and injection codes into hundreds of primary procedures from most specialties, including nearly all of the "Eye and Ocular Adnexa" surgery codes (60591-68850). Because those codes are renumbered versions of existing hydration, infusion, and injection codes, these new bundles represent updated versions of previous bundles. They are identical to bundles with the old codes (90760, 90765, 90772, 90774, and 90775). The only three eye surgery codes to escape that bundling frenzy were:

 • 65760 -- Keratomileusis
 • 65767 -- Epikeratoplasty
 • 65771 -- Radial keratotomy.

CCI marks most of these bundles with modifier indicator "1," which signifies that you can report the two codes in the bundle together if both procedures meet Medicare's definition for unbundling: "two or more procedures performed on different anatomic sites or during different patient encounters" (MLN Matters article SE0715). If the two procedures were performed on separate eyes during the surgery, you may be able to unbundle the services and report each procedure. You would need to append an appropriate modifier, such as modifier 59 (Distinct procedural service) or RT/LT (Right side/Left side), to the 907xx code. (See "Prevent Uni-Bi Reporting Errors With This Expert Insight," page 19.)

Tip: If you do report more than one modifier, list the one that unbundles first, says Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J., who led the session "Avoid Modifier Missteps" at The Coding Institute's February conference.

Exception: The bundles of the hydration, infusion, and injection codes into code 67221 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photodynamic therapy [includes intravenous infusion]) carry modifier indicator "0," which forbids you from ever reporting the bundled codes together, even with a modifier. This is because the descriptor specifies that the procedure "includes intravenous infusion," Mac explains.

Along with being bundled into new EK code 65756, corneal topography code 92025 is now also bundled into 65770 (Keratoprosthesis).

Watch for 92002-92014 Bundles

Previously, pediatric critical care services during an interfacility transport and neonatal/pediatric critical care services (codes 99289, +99290, and 99293-99300) contained eye exam codes 92002-92014 (Ophthalmological services: medical examination and evaluation ...). Now that those codes have been revised and renumbered for 2009, CCI 15.0 confirms that that decision still stands, bundling 92002-92014 into new critical care codes 99466-99476 and 99478-99480. All these bundles carry modifier indicator "0," forbidding unbundling.

CCI 15.0 also deleted the bundle that included 92002-92014 as a component of the "Welcome to Medicare" exam, G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment). HCPCS deleted that code in 2009, replacing it with G0402 (... services limited to new beneficiary during the first 12 months of Medicare enrollment) -- but CCI has not yet bundled 92002-92014 into G0402.