Ophthalmology and Optometry Coding Alert

Hundreds of procedures are now included with the new code for insertion of an aqueous drainage device.

If your ophthalmic surgeon has started using CPT® code 66183 (Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach), you had better heed the latest directives from the Correct Coding Initiative (CCI) if you want your claims to succeed.

This new code for 2014 describes an eye surgeon’s ability to use a single-piece stainless-steel implant which reduces intraocular pressure (IOP). You’ll use this code when implanting a surgical device in the treatment of refractory open-angle glaucoma to reduce intraocular pressure.

According to CCI version 20.0, which became effective Jan. 1, 2014, more than 200 procedure codes have been bundled into CPT® code 66183, including:

• Integumentary surgical repair (closure) procedure codes 12001-13153
• Venous procedure codes 36000-36410 and 36420-36440
• Arterial procedure codes 36600 and 36640
• Naso- or oro-gastric tube placement code 43752
• Bladder catheter codes 51701-51703
• Spinal therapeutic injection codes 62310-62319
• Nerve block injection codes 64400-64530
• Ocular anterior chamber incision codes 65800-65815
• Ocular anterior chamber injection codes 66020-66030
• Orbital injection codes 67500 and 67515
• Microsurgical technique code 69990
• Established patient ophthalmological exam codes 92012 and 92014
• Ophthalmological exam under general anesthesia codes 92018 and 92019
• Cardiography codes 93000-93010, 93040-93042, and 93318
• Pulmonary diagnostic test codes 94200, 94250, 94680-94690, and 94770
• EEG procedures 95812-95822 and 95955
• Infusion codes 96360-96365, 96372, and 96374-96376
• Moderate sedation codes 99148-99150
• More than 50 evaluation and management (E/M) codes in the 99211-99449 range.

Translation: Medicare and CCI consider the work in the procedures listed above to be an inherent part of the work performed in 66183, and therefore not billable separately.

Watch for: Some of the code pairs (for example, the bundling of the surgical repair procedures into 66183) are marked with modifier indicator “1,” which allows coders to report the codes separately with an appropriate modifier under appropriate clinical circumstances. Others (such as the bundling of spinal injections) are marked with modifier indicator “0,” which means that coders can never report the codes separately under any circumstances.

When a CCI edit pair shows a modifier indicator of “1,” you may use a modifier, where appropriate, but when the edit pair shows modifier indicator of “0,” you can never use a modifier, even if appropriate, according to Frank Cohen, principal and senior analyst for The Frank Cohen Group in Florida.

Learn more: For a complete list of edits, visit the CMS National Correct Coding Initiative page at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.