Ophthalmology and Optometry Coding Alert

Your vitrectomy claims could get a boost from this placement code.

When your ophthalmologist inserts a device for radiation or glaucoma drainage, delivers drugs with a mircocatheter, or scans an eye segment using light, reporting an emerging technology code can make the difference between its metamorphosis into a category I code or its death.

CPT 2009 revised its category III guidelines. After five years without a conversion to a category I code, the AMA will delete the category III code, says Jill Young, CPC, CEDC, CIMC, principle with Young Medical Consulting LLC in East Lansing, Mich.

Bill for Placing Macular Degeneration Applicator

Overlooking an add-on code when your ophthalmologist performs 67036 (Vitrectomy, mechanical, pars plana approach) could leave money unclaimed. Although the Medicare national fee schedule does not assign relative value units (RVUs) to category III codes, carriers may pay for the codes, such as +0190T (Placement of intraocular radiation source applicator [List separately in addition to primary procedure]).

Code 67036 is the route to get to placing the device, explained Michael X. Repka, MD, who spoke as the American Academy of Ophthalmologys CPT advisory committee member at the AMAs CPT and RBRVS Annual Symposium. By vitrectomy, the surgeon surgically places a device housing radioactive material in the eye.

For placing the device, you should also report +0190T.The new technology to treat macular degeneration (such as 362.50, Macular degeneration [senile], unspecified) lacked data to come on board as a category I code, notes Repka, who is professor of ophthalmology and pediatrics at John Hopkins in Baltimore.

Watch out: You will not code separately for the removal of the device and the closure of the entry wounds. The radiation oncologist, however, will report a code from the brachytherapy section for turning the radioactive source applicator on.

Find Glaucoma Drainage Devices Location

When coding for glaucoma drainage devices, dont sell your ophthalmologists work short with 66810. Coders may have used that code incorrectly for an aqueous drainage device, Repka says. Two new category III codes should replace the shunt code.

To zero in on the correct code, youve got to have a legible note describing the devices insertion location. The glaucoma drainage device can be inserted into the eyes anterior segment using an internal (0191T) or external (0192T) approach.

Internal: The ophthalmologist can insert the device across the eye from the inside to the outside, using a corneal or limbal incision, Repka explains. Code this as 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach).

External: Alternatively, the surgeon can push in the device from the outside through a conjunctival incision with creation of scleral flap. You should report the glaucoma drainage device insertion using this type of approach with 0192T (& external approach).

This is a bit of a difficult device to implant that requires a lot of different work depending on the approach used, Repka notes. Thus, the AMA created two codes.

Check Out 0186T for Nontraditional Drug Admin

If you didnt realize that there are three ways to inject a drug into the eye, you may be reporting the wrong code. A revision to a T code and a new T code should help you to avoid miscoding.

CPT 2008 actually created the following codes, but they did not appear in the CPT manual until 2009. Heres how to code for the three drug introduction methods.

" Intravitreal: An ophthalmologist may use intravitreal placement, which is clearly defined and priced.

" Extravitreal: For an outside-the-vitreous injection, you should be using 0124T (Conjunctival incision with posterior extrascleral placement of pharmacological agent [does not include supply of medication]). Effective Jan 1, 2008, extrascleral replaced juxtascleral for accuracy.The deleted term didnt help with coding the cases, explains Repka.

" Suprachoroidal: You can actually administer the drug between the retina and sclera by sliding a flexible catheter between the pearl/onion-like layers, Repka describes. Report suprachoroidal delivery, which eliminates the need for diffusion in the vitreous and the risks associated with traditional injections (infection, retinal detachment, glaucoma, or cataract formation) with 0186T (Suprachoroidal delivery of pharmacologic agent [does not include supply of medication]).

Helpful: For coders who are using 0124T, CPT added a parenthetical note to suggest that 0186T might apply. The note reads, For suprachoroidal delivery of pharmacologic agent, use 0186T.

Switch to 0187T When Scan Is Anterior

Back versus front determines whether a category I or a category III code applies.

Back: Anterior segment optical coherence tomography (OCT) did not fit under the existing posterior segment scanning code (92135, Scanning computerized ophthalmic diagnostic imaging, posterior segment, [e.g., scanning laser] with interpretation and report, unilateral). Anterior and posterior segment scans use different light wavelengths and require different machines.

Front: You should instead report anterior segment OCT with 0187T (Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral).

Warning: Considering opting for an unlisted procedure 99 code, rather than using a category III code? Dont, warns Young. Per CPT, a category III code must be used if it is available.