Ophthalmology and Optometry Coding Alert

Watch for documentation of medical necessity to break bundles.

Ophthalmic surgeons in the vanguard of high-tech treatments for age-related macular degeneration (AMD) may already be familiar with ocular telescope prosthesis technology, a tiny telescopic eye implant that gained FDA approval a couple of years ago.

The Correct Coding Initiative is certainly familiar with the temporary CPT® code introduced in mid-2012 to describe the insertion of the device — and with the latest version of the CCI edits, version 19.0, effective Jan. 1, you should be familiar with the new bundling rules for that code.

Code 0308T (Insertion of ocular telescope prosthesis including removal of crystalline lens) is bundled into these codes from the "Surgical Procedures on the Eye and Ocular Adnexa" section:

66982 -- Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex ...

66983 -- Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure)

66984 -- Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique ...

66985 -- Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal ...

66986 -- Exchange of intraocular lens

67108 -- Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique

67113 -- Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling ...

These codes are all Column 1 codes in bundles in which 0308T appears in Column 2, meaning that CCI sees them as comprehensive procedures which include the work described by 0308T. You should not report the two codes together, says CCI, because the work in 0308T would automatically be performed as part of, for instance, 66982.

Conversely, CCI 19.0 bundles 0308T as a comprehensive procedure with these component codes:

65426 -- Excision or transposition of pterygium; with graft

65750-65755 -- Keratoplasty (corneal transplant) ...

65772 -- Corneal relaxing incision for correction of surgically induced astigmatism

65775 -- Corneal wedge resection for correction of surgically induced astigmatism

65800-65815 -- Paracentesis of anterior chamber of eye (separate procedure) ...

65860-65880 -- Severing adhesions of anterior segment of eye ...

66020-66030 -- Injection, anterior chamber of eye (separate procedure)

66250 -- Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure

66500-66505 -- Iridotomy by stab incision (separate procedure)

66600-66635 -- Iridectomy, with corneoscleral or corneal section ...

66680 -- Repair of iris, ciliary body (as for iridodialysis)

66761 -- Iridotomy/iridectomy by laser surgery (e.g., for glaucoma)
(per session)

66820-66821 -- Discission of secondary membranous cataract ...

66825 -- Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)

66830 -- Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)

66840-66940 -- Removal of lens material ...

67005-67010 -- Removal of vitreous, anterior approach ...

67500-67505 -- Retrobulbar injection ...

67515 -- Injection of medication or other substance into Tenon’s capsule

67715 -- Canthotomy (separate procedure)

68200 -- Subconjunctival injection

92018-92019 -- Ophthalmological examination and evaluation, under general anesthesia ...

These codes are all Column 2 codes in bundles in which 0308T appears in Column 1, meaning that CCI sees them as components of a comprehensive procedure described by 0308T. You should not report the two codes together, says CCI, because the work in, for instance, 65426 would automatically be performed as part of 0308T.

Watch for: These edits are marked with modifier indicator "1," which indicates that CCI will allow you to report the two bundled codes separately if both procedures are clinically necessary -- for example, each performed on separate eyes -- and if the column 2 code is appended with a proper modifier, such as 59 (Distinct procedural service), notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.

Background: The FDA approved VisionCare Ophthalmic Technologies’ implantable miniature telescope in 2010, but the devices have only recently begun to see use. Physicians implant prosthetic intraocular telescopes to treat central vision loss in patients with end-stage age-related macular degeneration.

There is no current Category I code specific to this new procedure, so CPT® rules require you to report the temporary Category III code 0308T. Although the 0308T service does involve removal of the lens, the telescope implanted is not the same as an intraocular lens (IOL) prosthesis, and you should not report 0308T in addition to the codes for IOL procedures.

You also should not report operating microscope code 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) with 0308T, experts say.

Learn more: For the complete list of CCI edits, visit www.cms.gov/nationalcorrectcodinited.