Ophthalmology and Optometry Coding Alert

CPT^® 96361, 96366, 96367, 96368 bundles effect codes in virtually all specialties.

Ophthalmic surgeons may very rarely, if ever, use IV therapy during procedures – but the latest set of edits from the Correct Coding Initiative, version 22.1, effective April 1, want to make sure you don’t report the IV codes separately in any case.

CPT^® codes 96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]), 96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour [List separately in addition to code for primary procedure]), 96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]), and 96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion [List separately in addition to code for primary procedure]) have all been bundled into more than 225 of the “Surgical Procedures on the Eye and Ocular Adnexa” codes (65091-68850).

In fact, those three codes have been bundled into hundreds of other codes in all surgical specialties.

Key: These edits are all marked with modifier indicator “1,” which allows you to report the two bundled codes separately under the appropriate clinical circumstances, with a modifier like modifier 59 (Distinct procedural services) – in the unlikely chance that you’d need to.