Ophthalmology and Optometry Coding Alert
Include Moderate Sedation in Nearly All Eye Codes
Key: Role of second physician is critical in determining claims. If you thought CCI left no stone unturned in bundling moderate sedation, think again. Correct Coding Initiative (CCI) version 15.3, effective Oct. 1, continues the trend, bundling 99148-+99150 into most other CPT codes. Medicare allows no modifier to separate the bundles. Roughly 80 percent of the new bundles relate to moderate sedation codes 99148-+99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...), according to the Sept. 11 "NCCI 15.3 Update" news release by Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla. These edits carry a modifier indicator of "0," which means you can't override the edit with a modifier. Whether it's eye removals (65091-65114), lacrimal system procedures (68400-68850), or almost any other service in between, CCI edits bundle in various moderate sedation codes. But don't start counting the dollars you'll be losing if the bundled codes are 99148-+99150. As the descriptors indicate, these codes describe sedation by a second physician -- not by the physician performing the diagnostic or therapeutic service. So those edits shouldn't change how you code your claims for procedures. More information:
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