Attention,
ophthalmology coders : If you've been reporting cataract removal codes separately when you also report vitrectomies, then you need to stop. NCCI 9.1 bundles these procedures but leaves the door open for you to unbundle in certain cases because it has assigned an indicator "1" to these codes.
With the latest edition of the National Correct Coding Initiative, vitrectomy codes (67036-67040) now include several cataract removal codes:
66830 Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)
Removal of lens material (66840, 66920, 66930 and 66940)
Extracapsular and intracapsular cataract lens removal (66982, 66983 and 66984)
66985 Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
66986 Exchange of intraocular lens. Essentially, here NCCI bundles procedures that contain aspects that are too similar. "The lens removal codes are more extensive and may contain overlaps in the work performed for these vitrectomy codes," says ophthalmologist Michael Yaros, MD, a solo practitioner in Runnemede, N.J.
These bundles are common sense and correspond with current practice, according to Erica Kuntz, coding specialist with Northeast Ohio Eye Surgeons in Kent, Ohio. Take 66840 as an example: When you remove the lens material and aspirate it, you must do a vitrectomy to get the lens material out. The anterior vitrectomy code 67005 has long been included in the regular cataract removal code, 66984.
Also, 67010 (Removal of vitreous ... subtotal removal with mechanical vitrectomy) was bundled into 66984 in 1996, even though they are not always performed during this procedure. With 66983, there may be a higher incidence of vitrectomies because you're removing both the cataract and the capsule that the cataract is within. That could be the reason these bundles were created. As for the other cataract codes, NCCI bundles reiterate the understanding that if you have to do a vitrectomy, it is bundled, she says.
Considering NCCI assigned an indicator "1" with these edits, you may be able to unbundle these codes under circumstances befitting the application of modifier -59 (Distinct procedural service), such as during different sessions or on different eyes. Watch for E/M Bundles CCI bundles eye codes 92002-92014 (General ophthalmological services) with E/M codes (99201-99350). Also, the latest edits confirm the fact that you can't bill 99211 along with an eye code. CPT Deletions Affect CCI Edits Watch out for some other notable changes stemming from CPT 2003 deleted codes and iridectomy bundling:
Codes for fistulization of sclera for glaucoma (66150-66172) now include 66625 (Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma [separate procedure])
Deletion: G0185 and G0187 no longer include vitreous removal codes (67005-67010), 67141 (Prophylaxis of retinal detachment [e.g., [...]
