Ophthalmology and Optometry Coding Alert

The new edits also bundle 21282 (Lateral canthopexy) into 67916 and 67923. Those tarsal wedge excision codes also now include 67950 (Canthoplasty [reconstruction of canthus]) - both of which are now bundled into 21280 and 21282. All of these bundles appear with modifier indicator "1," which means Medicare will allow you to report the two codes together with modifier 59 (Distinct procedural service) if the clinical circumstances and documentation warrant it, says Sheryl Faison, CPC, inpatient coder for the department of ophthalmology at the University of North Carolina School of Medicine in Chapel Hill.
 
Canthoplasty (reinforcing the lower eyelid by cutting apart and repositioning the lateral canthal tendon) and canthopexy (placing a single suture in the canthus to reinforce the eyelid) are both often components of blepharoplastic surgeries, including ectropion and entropion repair. Ophthalmology practices rarely report 21280 or 21282 as separate procedures, says Vicky Murphy, CPC, coder and billing manager for Lake Eye Associates in Eustis, Fla.
 
Code 68720 is now mutually exclusive with 31239 (Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy), states NCCI 11.2. If you report the two together without a modifier, Medicare carriers will only pay for the procedure in column 1 of the edits, Faison says. Usually, as is the case with 68720, the lower-paying code is in column 1, she says - Medicare does this to discourage coders from improperly breaking mutually exclusive bundles.

Include Drug Administration in Most Procedures

 
Watch where you stick those injection G codes: NCCI 11.2 bundles three of them into virtually every eye procedure in the CPT manual.
 
NCCI also dictates that you will no longer be able to report G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), G0353 (Intravenous push, single or initial substance/drug) or G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]) with more than 250 eye surgery and ophthalmological services codes.
 
Medicare paid the drug administration codes plenty of attention in NCCI 11.2, bundling them with more than 4,000 procedures overall.
 
There are a few eye surgery codes that Medicare did not include in the bundling - but they are codes you don't stand much chance of being reimbursed for to start with. Noncovered procedures such as 65760 (Keratomileusis) and unlisted-procedure codes such as 67599 (Unlisted procedure, orbit) do not include any of the injection G codes.

Careful With Those Add-On Codes

Also missing from the bundles are add-on codes such as +67225 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photodynamic therapy, second eye, at single session [list separately in addition to code for primary eye treatment]). But since you must report these add-on codes in addition to a primary procedure - and the primary procedures themselves will include the injection G codes - the result is a de facto bundle, says Martha Bernardo, coder for Berkshire Eye and Laser Vision Correction Center in Pittsfield, Mass.
 
Don't miss: Earlier bundles included G0351, G0353 and G0354 - as well as 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) - bundled into these special ophthalmological services codes:
 

Codes G0345, G0347, G0353 and G0354 (but not G0351) are also included in 92287 (Special anterior segment photography with interpretation and report; with fluorescein angiography). Modifier indicator "1" appears with these edits, meaning that you may break the bundles with a modifier if necessary.
 
Note: To download the complete set of NCCI 11.2 edits, visit www.cms.hhs.gov/physicians/cciedits.