Ophthalmology and Optometry Coding Alert

Don't use an unlisted-procedure code for transciliary filtration--insurers now require this new code

If your ophthalmic surgeon performs transciliary filtration surgery on patients with intractable glaucoma, you'll be happy to see a new Category III code for this service in 2006.

CPT 2006 contains a new note under the current scleral fistulization codes, 66150-66172 (Fistulization of sclera for glaucoma ...), which directs you to 0123T (Fistulization of sclera for glaucoma, through ciliary body).

The FDA approved transciliary filtration (TCF) in October 2004. TCF, also known as "Singh filtration," is an alternative to trabeculectomy for phakic chronic open angle glaucoma patients. Ophthalmic surgeons use a plasma blade (called a Fugo blade) to incise a small opening in the sclera and ciliary body, allowing intraocular fluid to drain into the eye's lymphatic system.

Experts hail TCF as quicker than trabeculectomy, causing less bleeding and fewer postoperative complications.

If the New Code Fits, Quit Reporting 66999

Since Category III codes are temporary national codes, Medicare does not assign them relative value units (RVUs) in the Physicians Fee Schedule. But don't be tempted to replace 0123T with an unlisted-procedure code (such as 66999, Unlisted procedure, anterior segment of eye) to report TCF: CPT rules direct that if a Category III code is available, you must report it instead of an unlisted-procedure code, says Mary Harper, CPC, coder and office manager for Hampton Roads Eye Associates in Newport News, Va.

Expert advice: Work with your ophthalmologist when negotiating with your carrier for reimbursement for 0123T, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. "I ask providers to determine what they feel is their cost to perform the procedure, which includes their expertise and work time," she says.
 
Don't just use an existing Category I code as a basis for comparison--for many CPT codes, "the RVUs assigned don't make any sense whatsoever for a lot of services," Mac says.

Eyeball the New Codes for Macugen, Retaane

CPT 2006 introduces another new Category III code, 0124T (Conjunctival incision with posterior juxtascleral placement of pharmacological agent [does not include supply of medication]), to describe an experimental procedure in which the surgeon places a depot suspension of Retaane behind the globe, through a catheter passing through a conjunctival incision.

Some ophthalmic surgeons may soon be turning to anti-angiogenic therapy to treat macular degeneration. Ophthalmologists can insert a new drug, Retaane (anecortave acetate), behind the eye instead of directly into the eyeball.

The FDA has found Retaane to be "approvable," and the drug may be on the market soon.
 
Macugen (pegaptanib sodium), another drug often used to treat macular degeneration, gets a HCPCS code for the drug supply in 2006. Starting Jan. 1, report  J2503 (Injection, pegaptanib sodium, 0.3 mg) for the supply, along with 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) for the injection itself. It will be up to the individual carrier to determine reimbursement.

Other new Category III codes for developing technology include:

• 0099T (Implantation of intrastromal corneal ring segments), describing the use of Intacs corneal inserts with keratoconic patients to reduce the need for corneal transplants

• 0100T (Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intraocular retinal electrode array, with vitrectomy), describing an artificial retina, now in development, involving a small external camera transmitting electrical impulses to a receiver in the back of the eye.

Rely on E/M Codes for Eye Fitting

In 2006, you'll also say goodbye to some codes dealing with ocular prostheses and spectacle services--but chances are, you won't miss them much.

CPT 2006 deletes 92330 (Prescription, fitting and supply of ocular prosthesis [artificial eye], with medical supervision of adaptation) and 92335 (Prescription of ocular prosthesis [artificial eye] and direction of fitting and supply by independent technician, with medical supervision of adaptation).

New instructions direct you to report an E/M code or general ophthalmological service code (92002-92014) in place of the deleted codes.

Similarly, CPT 2006 deletes all of the "Supply of Materials" codes (92390-92396), covering the supply of spectacles, contact lenses, low vision aids and ocular prostheses. Revised instructions in the "Contact Lens Services" section read, "The supply of contact lenses may be reported as part of the service of fitting. It may also be reported separately by using the appropriate supply codes."

Report contact lens supplies for aphakic patients using the HCPCS V25xx codes (for example, V2510, Contact lens, gas permeable, spherical, per lens, or V2522, Contact lens, hydrophilic, bifocal, per lens), Harper says. Append modifiers RT and LT (Right side and left side) for each eye and modifier KX (Specific required documentation on file) to indicate medical necessity.

Don't code separately for lenses for keratoconic patients, says Loetta Morales, insurance specialist for Gorovoy Eye Specialists in Fort Myers, Fla. For the fitting, report 92070 (Fitting of contact lens for treatment of disease, including supply of lens). Because 92070 specifies that supplies are included, do not code separately for them.