NCCI 11.0 Update:
Not Reporting Cataract Extractions With Pars Plana Vitrectomies? Now You Can
Published on Tue Jan 18, 2005
The first coding bundles of 2005 also tell you what you can - and can't - bill with the new ECP code Attention, coders: If you're tired of getting denials when you bill cataract removals with vitrectomies, NCCI version 11.0 has some good news for you. Starting Jan. 1, 2005, you'll be able to report three cataract extraction codes along with mechanical pars plana vitrectomy codes.
The latest edition of the National Correct Coding Initiative edits deletes a group of bundles that had been in place since April 2003. As a result, these CPT codes: 66982 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique, complex, requiring devices or techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage
66983 - Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one-stage procedure)
66984 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique are no longer bundled into these CPT codes: 67036 - Vitrectomy, mechanical, pars plana approach
67038 - ... with epiretinal membrane stripping
67039 - ... with focal endolaser photocoagulation
67040 -... with endolaser panretinal photocoagulation. Exception: NCCI 11.0 does not get rid of all the vitrectomy/cataract bundles. Codes 67036-67040 do still include code 66830 (Removal of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid] with corneo-scleral section, with or without iridectomy [iridocapsulotomy, iridocapsulectomy]), as well as most of the lens material removal codes 66840-66940.
NCCI also still considers the IOL codes, 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) and 66986 (Exchange of intraocular lens), part of the 67036-67040 procedures.
Most of the remaining bundles are marked with a status indicator of "1," which means that you may use modifiers to break the bundles and report the two procedures separately if circumstances allow, says Donna Marks, CPC, CCS-P, OCS, ophthalmology coder for the Lahey Clinic in Peabody, Mass. Don't Report Iridotomies With New ECP Code Coders and ophthalmologists rejoiced when CPT announced that 66711 (Ciliary body destruction; cyclophotocoagulation, endoscopic) would appear in the 2005 manual. This new code provides a way to report the ophthalmologist's use of an endoscopic laser to treat the ciliary body, a procedure known as endoscopic cyclophotocoagulation (ECP). Now NCCI is weighing in on what procedures you should not report separately with 66711.
According to NCCI 11.0, 66711 includes these procedures your ophthalmologist might perform:
Anterior chamber incision codes 65800-65860
Anterior chamber adhesion severing codes 65865-65880
Anterior chamber injection codes 66020-66030
Iridotomy codes 66500-66505
Iridectomy codes 66625-66635
Endoscope code +66990 (Use of ophthalmic endoscope [list separately in addition to code for primary procedure])
Injection code 67500 (Retrobulbar injection; medication [...]
