Ophthalmology and Optometry Coding Alert

Virtually all of the nerve block injection codes are now bundled into endothelial keratoplasty.

Is your ophthalmology practice in the habit of billing for anesthesia injections along with endothelial keratoplasty (EK) procedures? Effective April 1, 2011, you'd better think before you code, according to version 17.1 of the Correct Coding Initiative (CCI).

Non-mutually exclusive edits apply to services that a physician might perform during the same care session but that aren't billable together. This is because one of the codes (the Column 2 or component code) is included in the services represented by the Column 1 (comprehensive) code of the pairing. You can bill individual components if the physician does not perform the entire comprehensive procedure.

But if the physician performs the entire (comprehensive) procedure, you are required to bill the comprehensive code instead of the individual parts or components, says Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, Director of Network Oversight for the Mount Sinai Medical Center Compliance Department in New York City.

Bundle Anesthetic Agent Injections Into EK Code

With CCI's addition of several new bundled codes, code 65756 (Keratoplasty [corneal transplant]; endothelial) now includes nearly all of the "Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic" codes (64400-64530). CCI marks most of these bundles with modifier indicator "0," which prevents you from reporting the bundled codes separately under any circumstances, even with an appropriate modifier.

In addition, CCI 17.1 will also bundle these codes into 65756:

• 36400-36406 -- Venipuncture, younger than age 3 years ...
• 36420-36425 -- Venipuncture, cutdown ...
• 36430 -- Transfusion, blood or blood components
• 36440 -- Push transfusion, blood, 2 years or younger
• 43752 -- Naso- or oro-gastric tube placement ...
• 62310-62311 -- Injection, single ... of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid ...
• 93000-93010 -- Electrocardiogram ...
• 93040-93042 -- Rhythm ECG ...
• 93318 -- Echocardiography, transesophageal ...
• 94002 -- Ventilation assist and management ...
• 94200 -- Maximum breathing capacity, maximal voluntary ventilation
• 94250 -- Expired gas collection, quantitative, single procedure (separate procedure)
• 94680-94690 -- Oxygen uptake, expired gas analysis ...
• 94770 -- Carbon dioxide, expired gas determination by infrared analyzer
• 95812-95822 -- Electroencephalogram (EEG) ...
• 95829 -- Electrocorticogram at surgery (separate procedure)
• 95955 -- Electroencephalogram (EEG) during nonintracranial surgery (e.g., carotid surgery).

CCI marks most of these bundles with modifier indicator "1," allowing you to report the codes separately with an appropriate modifier when circumstances for unbundling are met, says Mac.

Watch for Aqueous Drainage Bundles

CCI 17.1 also declares CPT codes 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 injectino of antifibrotic agents]) and 66180 (Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]) mutually exclusive with 0253T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space).

CCI had already declared 66170, 66172, and 66180 to be mutually exclusive with similar CPT Category III (temporary) codes 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork) and 0192T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach).

Anterior segment aqueous drainage devices (such as the iStent Trabecular Micro-Bypass Stent) inserted internally or externally without an extraocular reservoir are a new treatment many ophthalmologists are using as a method to reduce intraocular pressure for the treatment of glaucoma. However, many insurers consider these devices investigational and not medically necessary.

FYI: CCI 17.1 includes 709,527 active edit pairs, according to an analysis by Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla. Check the latest version at www.cms.gov to ensure you correctly report procedures.