Ophthalmology and Optometry Coding Alert

Tip: You can report a Column 2 code with a Column 1 code – but only under certain circumstances.

As of Jan. 1, ophthalmology coders have several new CPT^® codes to add to their coding arsenals. And also as of Jan. 1, coders have a new set of rules from the Correct Coding Initiative (CCI) about which codes can be reported together.

CCI 22.0 introduces more than 55,000 new coding bundles, more than a few of which have implications for ophthalmology practices.

Corneal Ring Segments Receive 200 New Bundles

A new CPT^® code for 2016, 65785 (Implantation of intrastromal corneal ring segments), received nearly 200 new Column 2 codes, with a mix of modifier indicators 1 and 0. The Column 2 CPT^® codes include most of the simple, intermediate, and complex repairs to the integumentary system (12001-13153), several venous and arterial procedures from the 36xxx family, and codes from the 64400-64530 series (“Introduction/Injection of Anesthetic Agent [Nerve Block], Diagnostic or Therapeutic Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System”). However, the only CPT^® codes from the Eye and Ocular Adnexa series newly bundled into 65785 are:

• 67500 – Retrobulbar injection; medication (separate procedure, does not include supply of medication)
• 68200 – Subconjunctival injection.

In turn, 65785 was bundled into 65772 (Corneal relaxing incision for correction of surgically induced astigmatism) as a component of the comprehensive code; and into 65775 (Corneal wedge resection for correction of surgically induced astigmatism) as a mutually exclusive code pair. All four of these edits are marked with modifier indicator 1.

Rationale: It’s unclear why CCI took this action, “as it seems unlikely they would have ever been performed together anyway,” notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.

New Edits Impact New Temporary Collagen Code

A new temporary code in CPT^® 2016, 0402T (Collagen cross-linking of cornea [including removal of the corneal epithelium and intraoperative pachymetry when performed]), also received hundreds of new Column 2 codes, including:

• 65275 – Repair of laceration; cornea, nonperforating, with or without removal foreign body
• 65280 – … cornea and/or sclera, perforating, not involving uveal tissue
• 65285 – … cornea and/or sclera, perforating, with reposition or resection of uveal tissue
• 65430 – Scraping of cornea, diagnostic, for smear and/or culture
• 67250 – Scleral reinforcement (separate procedure); without graft
• 67500 – Retrobulbar injection; medication (separate procedure, does not include supply of medication).

0402T was itself bundled into:

• 65220 – Removal of foreign body, external eye; corneal, without slit lamp
• 65222 – … corneal, with slit lamp
• 65435 – Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage).

65855 (Trabeculoplasty by laser surgery) was bundled into:

• 65860 – Severing adhesions of anterior segment, laser technique (separate procedure)
• 65865 – Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae
• 65870 –... anterior synechiae, except goniosynechiae
• 65875 –... posterior synechiae
• 65880 –... corneovitreal adhesions.

Rationale: The edits “may have something to do with the use of the laser for a trabeculoplaty,” Mac notes.

Check These Anesthesia Edits

Three anesthesia codes introduced in CPT^® 2016 have been bundled into thousands of procedure codes, including approximately 265 Eye and Ocular Adnexa codes. CPT^® 61650 (Endovascular intracranial prolonged administration of pharmacologic agent[s] other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory), 64461 (Paravertebral block [PVB] [paraspinous block], thoracic; single injection site [includes imaging guidance, when performed]), and 64463 (… continuous infusion by catheter [includes imaging guidance, when performed]) became Column 2 codes to thousands of other codes.

The 61650 edits were marked with modifier indicator 1, 64461 and 64463 with 0.