Ophthalmology and Optometry Coding Alert

The latest Correct Coding Initiative update includes over 230,000 new edit pairs.

Every quarter coders wait with bated breath to see the effect the latest round of Correct Coding Initiative (CCI) will have on their coding. CCI 18.3 is a doozy.

"In the 15 years or so that I have been analyzing the NCCI database, this release will go down in history as the Ripley's Believe it or Not quarterly change," warns Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. "Effective October 1, 2012, there will be 233,242 new edit pairs added to the database. So, in addition to the overwhelming volume of reasons that payers use to deny payment to a practice, you can add 1 million more, which is just about the size of the new NCCI database. Over 97 percent of these were surgical procedures (codes 10000 through 69999) and almost all fell within the policy statement of 'Misuse of Column 2 code with Column 1 code.'"

This latest batch of CCI edits bundles a number of integumentary repair CPT® codes into virtually all of the "Surgical Procedures on the Eye and Ocular Adnexa" codes (65091-68899). Specifically, these codes are Column 2 codes bundled into more than 260 eye surgery procedures:

• 12001-12021 -- Simple repair of superficial wounds ...
• 12031-12057 -- Repair, intermediate ...
• 13100-13153 -- Repair, complex ...

Translation: CCI has determined that those integumentary repair codes are an intrinsic part of nearly all of the eye surgery codes, and as such should not be coded or billed separately. All of these new edit bundles are marked with modifier indicator "1," which indicates that you may use a modifier to override the edit if the clinical circumstances warrant separate payment.

"If a physician does an incisional biopsy of the eyelid, including lid margin (CPT® code 67810) and also performs a separate eye lid biopsy (11100, 11101, 11310-11313) on the same eyelid or the other eyelid, the billing would require a modifier 59 (Distinct procedural service)," says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla. "Removal of lesions involving mostly the skin of the eyelid would utilize codes 11310-11313, 11440-11446, 11640-11646, and/or 17000-17004."

In addition, CCI 18.3 has declared certain lens surgery procedures to be mutually exclusive to other similar procedures. For example, as of October 1, lens material removal codes 66850-66984 (Removal of lens material ...) are now considered mutually exclusive with 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 (Removal of lens material; aspiration technique, 1 or more stages), and 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [1 stage procedure]), among others.

Learn more: For complete information on the latest update to the Correct Coding Initiative, visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd. You can also look up bundles for individual codes at https://www.aapc.com/codes/.