Ophthalmology and Optometry Coding Alert

Watch out: 67500 is now bundled into all but 16 eye codes

The latest National Correct Coding Initiative edits, version 10.2, effective July 1, bundle 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]) into more than 200 eye procedures. This, when added to previous bundles, means that 67500 is part of the global package of the majority of eye surgery codes.

The new bundles clarify Medicare's existing policy for 67500, says Sheila Key, CPC, CPC-H, coding and compliance consultant for Health Inventures, an ASC consulting and management company in Superior, Colo. The rationale NCCI gives for the edits (the "Standard Policy Statement") maintains that "anesthesia [is] included in surgical procedures."

Since the description of the CPT code specifies "separate procedure," Key says "it seems like it wouldn't even need an NCCI edit" to assert that the retrobulbar injection should be considered part of an eye surgery code. Some coders, however, continued to report 67500 separately, prompting the NCCI edit, Key says.

Don't overlook: All of the 67500 bundles -- the new ones in addition to the existing ones -- have a modifier status indicator of "1." This means that, in theory, you can report the two procedures together under certain circumstances by adding a modifier to 67500 and including documentation with your claim.

Warning: This would only be appropriate if the ophthalmologist performed the retrobulbar injection for reasons other than anesthesia for the other reported procedure, Key says. However, Key can't think of any scenarios in which reporting 67500 separately would be necessary. "As a separate procedure, I never would have reported it," she says.

Although most payers already bundled lidocaine payment into your injection fees, a new National Correct Coding Initiative (NCCI) edit officially points to 178 eye surgery codes you should not report J2001 with.

Hidden trap: HCPCS deleted J2000 (Injection, lidocaine HCl, 50 cc) this year and introduced J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg). Although most coders accurately took this as a sign that Medicare would no longer allow them to report lidocaine for the small amount of anesthetic injected for pain management, some coders simply changed their claim forms and started billing J2001 with every lidocaine injection.

Wrong, says Maggie M. Mac, CMM, CPC, a health management consultant and national seminar leader for McVey Associates. "J2001 specifies an IV infusion of the anesthetic, not a local injection," she says. "J2001 is not a replacement code for J2000. Administration of lidocaine is completed through a different avenue of administration -- intravenous (IV) versus local intramuscular (IM)."

NCCI 10.2, effective through Sept. 30, shuts the door on any ambiguity, bundling J2001 into 178 eye surgery codes -- including evisceration, enucleation and exteneration of the eye, chalazion excision, blepharoptosis repair and conjunctivoplasty.

For a complete list of NCCI edits, visit the CMS site www.cms.hhs.gov/medlearn/ncci.asp.