Ophthalmology and Optometry Coding Alert

Thinking of reporting an injection separately from a cataract removal?  Think again.

With just over 1,100 edit bundles added, Correct Coding Initiative (CCI) Version 21.1, effective April 1, may seem like no big deal to many practices. Yet if your practice frequently performs anterior segment, intravitreal, or subconjunctival injections, your coding may need adjustment.

Background: The Correct Coding Initiative releases a list every quarter of pairs of codes that should not be reported together. These edits can be “Column 1/Column 2” edits, or “Mutually Exclusive” edits. In Column 1/Column 2 pairs, CCI considers the Column 2 code to be a component of column 1, and thus not separately reportable. Mutually exclusive codes represent services that could probably not be performed at the same time.

The code edits in version 21.1 are Column 1/Column 2 edits. If they are reported together, Medicare carriers will only reimburse for the comprehensive (Column 1) code.

As of April 1, CCI considers CPT® code 66030 (Injection, anterior chamber of eye [separate procedure]; medication) a component of:

• 66820-66821 – Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid)…

• 66840-66940 – Removal of lens material…

• 66986 – Exchange of intraocular lens.

CPT® code 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) is now bundled into:

• 66820-66821

• 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

• 66982-66984 – Cataract removal…

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

• 66986

CPT® code 68200 (Subconjunctival injection) is now bundled into:

• 66820-66821

• 66825-66940

• 66983

• 66985

• 66986

CCI sites “Misuse of column 1 code with column 2 code” as the reason for these edits affecting 68200.

History repeats: Although 68200 had previously been bundled into code 66930 (Removal of lens material; intracapsular, for dislocated lens), CCI 21.1 completes the series by bundling 68200 into the remainder of the codes in the 66840-66940 series. 

Similarly, 68200 had already been bundled into codes 66982 (Extracapsular cataract extraction with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage) and 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]); with this versions bundle of the service into 66983, it is now bundled into all of the cataract removal codes.

Unbundle of joy: CCI marks all of these edits with modifier indicator “1,” which means that it is permissible to report both of the codes, if clinical circumstances justify it and the component (Column 2) code is appended with an appropriate modifier.

Low impact: “It would be unusual for these services to be performed together,” says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla. “I don’t think this will affect practices too much.”

Learn more: For a complete list of CCI edits, visit http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.