Ophthalmology and Optometry Coding Alert

Know when you can — and can’t — split bundles.

When certain procedures are a standard part of more comprehensive services that your ophthalmologist performs, you can be certain Medicare’s Correct Coding Initiative (CCI) will establish edit pairs that you need to know. Such is the case with CCI 19.1, effective April 1, 2013.

The latest Correct Coding Initiative (CCI) update is “probably the smallest impact I have seen since the beginning of the program,” according Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC.

However, if your ophthalmologist is using a relatively new code for the fitting of a therapeutic contact lens, you will need to know the new CCI rules.

According to the new set of CCI edits, CPT^® code 92071 (Fitting of contact lens for treatment of ocular surface disease), introduced in 2012, is now bundled into:

·         65220-65222 — Removal of foreign body, external eye ...

·         65275-65286 — Repair of laceration ...

·         65400 — Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

·         65410 — Biopsy of cornea

·         65420 — Excision or transposition of pterygium; without graft

·         65426 — Excision or transposition of pterygium; with graft

·         65430-65600 — Removal or destruction procedures on the cornea

·         65710-65757 — Keratoplasty procedures on the cornea

·         65760-65782 — Other procedures on the cornea.

“This is kind of a low blow to physicians,” says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla. “The bundle assumes that the fitting of the lens is always done with the aforementioned procedures, and that is not necessarily true.”

The new bundles are not likely to have a huge impact on practice revenues, Mac says, because there is only one relative value unit (RVU) assigned to the code for services provided in the office.

These edits all carry a modifier indicator of “1,” meaning that you can use a modifier to break the bundle under the appropriate clinical circumstances, and report the two bundled codes separately.

For more information on the Correct Coding Initiative, visit www.cms.gov/nationalcorrectcodinited .