Ophthalmology and Optometry Coding Alert

There are over 300,000 new edit pairs -- how many will impact ophthalmology coding?

If you thought CCI versions after January were pretty tame, get ready for a big surprise. The Correct Coding Initiatives (CCIs) version 15.1, which went into effect on April 1, adds over 304,000 new edit pairs to its already massive list -- increasing the total present-day CCI database to 629,107 edit pairs.

Of most concern to ophthalmology coders are the bundles affecting your vitrectomy and blepharoplasty coding, experts say.

The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

On the radar: CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, and only 48 codes make up the top 80 percent of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in a March 12 news release.

The codes that received the most new bundles are not ones ophthalmology coders use often. The top most commonly occurring codes in column 2 of the new nonmutually exclusive edits are 94250 (Expired gas collection, quantitative ...), 94680-94690 (Oxygen uptake, expired gas analysis ...), 95812-95819 (Electroencephalogram), and 96376 (Therapeutic, prophylactic, or diagnostic injection ...; each additional sequential IV push ...), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

For example: These codes are bundled into most of the procedures in the integumentary,musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran with CGH Billing in Louisville, Ky.

Vitrectomy Codes Now Bundled With 67030-67031

If youre accustomed to reporting vitreous strand procedures with vitrectomy procedures, CCI 15.1 would like you to stop. Codes 67030 (Discission of vitreous strands [without removal], pars plana approach) and 67031 (Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery [1 or more stages]) are now in a mutually exclusive bundle with 67042 (Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina [e.g., for repair of macular hole, diabetic macular edema], includes, if performed, intraocular tamponade [i.e., air, gas or silicone oil]) and 67043 (& with removal of subretinal membrane [e.g., choroidal neovascularization], includes, if performed, intraocular tamponade [i.e., air, gas or silicone oil] and laser photocoagulation).

Thats all, folks: With this update, CCI has placed all of the pars plana mechanical vitrectomy codes, starting with 67036 (Vitrectomy, mechanical, pars plana approach), into various kinds of bundles with 67030 and 67031. Previous CCI edits placed 67039 (& with focal endolaser photocoagulation), 67040 (& with endolaser panretinal photocoagulation), and 67041 (& with removal of preretinal cellular membrane [e.g., macular pucker]) into mutually exclusive bundles with 67030 and 67031.

And 67030 and 67031 are bundled into 67036 through column 1/column 2 edits. Since codes 67036-67043 already include removing the vitreous, other codes for removing or dissecting small areas or amounts of vitreousare bundled with them.

Good to know: CCI places codes that providers would not normally perform together into mutually exclusive bundles. Here are the mutually exclusive bundles affecting codes 67030-67043:*Effective April 1, 2009

The new CCI marks each of these bundles with modifier indicator 1, meaning that you can override these edits with a modifier under the proper circumstances.

CCI previously bundled 67030 and 67031 as components of 67036. Likewise, CCI also bundles 67036 as components of 67039, 67040, 67041, 67042, and 67043.

CCI Transforms Bleph Bundles

New bundles also make code 15822 (Blepharoplasty, upper eyelid) mutually exclusive with all of the blepharoptosis codes 67901-67908 (Repair of blepharoptosis &).The edits delete previous CCI edits that made them column 1/column 2 codes, transforming them into mutually exclusive edits. However, 15820 (Blepharoplasty, lower eyelid) remains a column 2 code bundled into column 1 codes 67901-67908.

Code 15823 (Blepharoplasty, upper eyelid; with excessive skin weighting down lid) becomes mutually exclusive with 67901 (Repair of blepharoptosis; frontalis muscle technique with suture or other material [e.g., banked fascia]), 67902 (& frontalis muscle technique with autologous fascial sling [includes obtaining fascia]), and 67904 (& [tarso] levator resection or advancement, externalapproach), with the 6790x codes in column 1. However, code 15823 is the column 1 procedure in new mutually exclusive bundles with 67903 (& [tarso] levator resection or advancement, internal approach), 67906 (& superior rectus technique with fascial sling [includes obtaining fascia]), and 67908 (& conjunctivo-tarso-Mullers musclelevator resection [e.g., Fasanella-Servat type]).

Heres a breakdown of the new mutually exclusive blepharoplasty bundles. CCI has determined that ophthalmologists would not normally perform both the column 1 and column 2 procedures on the same day:

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These bundles are marked with modifier indicator 1.

Watch for: New codes for 2009 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach) and 0192T (& external approach) are both bundled into a mutually exclusive pairing with 66170 (Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery), 66172 (& trabeculectomy ab externo with scarring from previous ocular surgery or trauma [includes injection of antifibrotic agents]), and 66180 (Aqueous shunt to extraocular reservoir [e.g., Molteno,Schocket, Denver-Krupin).

Because 66170, 66172, and 66180 describe external drainage, you would not report 0191T or 0192T (which describe an internal drainage device) at the same time.