Ophthalmology and Optometry Coding Alert

Note modifier indicators to see if separate reporting is possible.

Amid the thousands of edit pairs in the Correct Coding Initiative (CCI) Version 20.3, effective Oct. 1, about a dozen may have an impact on your ophthalmology practice.

There are 5,247 new edit pairs in CCI 20.3, bringing the total number of active edits to 1,340,210, says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla.

Of interest to ophthalmology coders:

HCPCS code V2790 (Amniotic membrane for surgical reconstruction, per procedure) has been bundled into CPT® codes 65778 (Placement of amniotic membrane on the ocular surface; without sutures) and 65779 (… single layer, sutured). 

CPT® code 65778 describes a procedure in which amniotic membrane is placed on the ocular surface similar to what you do with a contact lens. The membrane can sit on the eye for several days while the eye is healing. Code 65779 describes a similar process, with suturing the membrane into place. Both codes debuted in CPT® 2011.

Rationale: The new code pair edits clarify that the supply of the amniotic membrane (V2790) is included in the procedure. CCI gives the edits a modifier indicator of “0,” which means that the V2790 cannot be reported with 65778 or 65779 under any circumstances.

If an ophthalmology coder were to (erroneously) report the two codes together, Medicare payers would only reimburse for the column 1 code — in this case, 65778 or 65779. The rationale given for the edit is “Misuse of column two code with column one code.” 

CCI 20.3 also introduces a number of new edits involving a temporary Category III CPT® code, 0356T (Insertion of drug-eluting implant [including punctual dilation and implant removal when performed] into lacrimal canaliculus, each). The code, part of Category III, which describes new and emerging technology, was introduced effective July 1, 2014.

The code describes the insertion (and removal, when performed) of implants designed to help reduce postoperative inflammation and pain, as well as reduce of intraocular pressure in patients with glaucoma or ocular hypertension. The manufacturer, Ocular Theraputix, is currently in clinical trials with the implants. 

Effective Oct. 1, CCI has bundled these codes into 0356T:

• 67500 — Retrobulbar injection; medication (separate procedure, does not include supply of medication)
• 68440 — Snip incision of lacrimal punctum
• 68530 — Removal of foreign body or dacryolith, lacrimal passages
• 68700 — Plastic repair of canaliculi
• 68770 — Closure of lacrimal fistula (separate procedure)
• 68801 — Dilation of lacrimal punctum, with or without irrigation
• 68810 — Probing of nasolacrimal duct, with or without irrigation
• 68811 — … requiring general anesthesia
• 68815 — … with insertion of tube or stent
• 68816 — …with transluminal balloon catheter dilation
• 68840 — Probing of lacrimal canaliculi, with or without irrigation.

More than 180 CPT® codes total have been bundled into 0356T. All of the edits are marked with modifier indicator “1,” which allows coders to report the two codes in the pair separately with an appropriate modifier (such as modifier 59, Distinct procedural service) under the appropriate clinical circumstances.

The whole story: For a complete list of CCI edits, visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.