Ophthalmology and Optometry Coding Alert

are no longer bundled into these CPT codes:  

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:
 

All of these new bundles are marked with a status indicator of "1," which means you can use modifiers, when appropriate, to break the bundles.

The new code edits also list 66711 as mutually exclusive with existing ciliary body destruction codes. NCCI has determined that an ophthalmologist would not normally perform 66711 along with 66700-66740 (Ciliary body destruction) or 66770 (Destruction of cyst or lesion iris or ciliary body [nonexcisional procedure]) at the same session. However, status indicator "1" allows you to report the codes together with the appropriate modifier.

Welcome G Codes for 'Welcome to Medicare' Visits

Jan. 1, 2005, will also see the debut of two new temporary G codes: the initial hospice evaluation code G0337 (Hospice evaluation and counseling services, pre-election) and G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) - often called the "Welcome to Medicare" visit. Both of these new codes include eye examination codes 92002-92014 as components.

A "visual acuity screen" is one of the screening tests doctors can perform as part of the "Welcome to Medicare" physical. Ophthalmologists, however, are not likely to bill either of the new G codes, since they would not be performing complete physical exams, so this should not be a problem, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. "This service is more likely to be offered from family practice or internal medicine providers,"   Mac says.

Use Modifiers to Unbundle IV Infusion

Medicare has also introduced two new IV infusion codes for 2005, but good luck billing them alongside other procedures unless you can justify using a modifier.

For example, G0345 (Intravenous infusion, hydration; initial, up to one hour) and G0347 (Intravenous infusion, for therapeutic/diagnostic [specify substance or drug]; initial, up to one hour) will each become components of six codes:
 

All of these procedures necessarily involve injections of either anesthetic or contrast material. Codes G0345 and G0347 will also become components of nearly all the eye surgery codes.

In fact, NCCI 11.0 bundles the two temporary codes into a staggering 5,687 CPT codes. You'll be able to report most of these codes separately with a modifier.

However: One exception is CPT code 67221 (Destruction of localized lesion of choroids [e.g., choroidal neovascularization]; photodynamic therapy [includes intravenous infusion]). It is bundled with G0345 and G0347 in NCCI 11.0 and marked with status indicator "0," which means that the bundle cannot be broken under any circumstances, says Paula Okano, CPC, medical biller for Retina Associates of Hawaii in Honolulu.

The CPT descriptor already notes that 67221 includes intravenous infusion, so there should be no need to report G0345 or G0347 as well.

Watch for: Two other new G codes, G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) and G0353 (Intravenous push, single or initial substance/drug), are bundled into 92230, 92235 and 92240. Code G0353 is also bundled into 67221 and 92287.

Look Out for These Mutually Exclusive Codes

Two other NCCI edits to watch for:

The code for Botox injection to the strabismus muscle, 67345 (Chemodenervation of extraocular muscle), now includes the needle guidance by electromyography codes 95860-95870 (Needle electromyography). You may not unbundle these codes.

IOL master code 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) is mutually exclusive with A-scan code 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). You may not unbundle these codes, either.

Note: See "Get the NCCI 11.0 Skinny Here" in this issue for more information on NCCI edits effecting ophthalmology coders.