Ophthalmology and Optometry Coding Alert

You can break the bundles with modifier 59 -- but only in certain circumstances.

If your ophthalmologist wants to treat obstructive meibomian gland dysfunction (MGD) with a new automated device, there's good news and bad news. The good news: There is a temporary category III CPT® code to describe the use of new technology to evacuate the meibomian glands. The bad news: The latest version of the Correct Coding Initiative (CCI) will restrict how you can use that code with other eyelid procedures, as of July 1, 2011.

CPT® code 0207T (Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral), introduced in 2010, is now included in:

• 67800 -- Excision of chalazion; single
• 67801 -- ...multiple, same lid
• 67805 -- ...multiple, different lids
• 67808 -- ...under general anesthesia and/or requiring hospitalization, single or multiple
• 67840 -- Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure
• 67850 -- Destruction of lesion of lid margin (up to 1 cm).

A previous version of CCI bundled 0207T into 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]).

CCI marks all of these bundles with modifier indicator "1," which indicates that coders can report the two codes separately, when appropriate, by appending a modifier to the column 2 code, 0207T, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director of Network Oversight at Mount Sinai Medical Center Compliance Department in New York City.

Dysfunctional meibomian glands often cause dry eyes or even blepharitis, as the dry eyeball rubs off small pieces of skin from the eyelid, which may get infected. MGD causes the glands to be obstructed by thick waxy secretions.

Typical treatments for MGD include warm compresses, lid scrubs, antibiotic supplements or ointments, and Omega 3 supplements. The use of an automated device to evacuate the meibomian glands is a new technology that the FDA has not yet approved.

CCI version 17.2, which takes effect July 1, 2011, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC.