Ophthalmology and Optometry Coding Alert

New National Correct Coding Initiative edits also bundle 99143-99144 into most E/M codes

Bad news: The latest NCCI update includes one massive edit that affects over 500 CPT codes. Good news: Ophthalmic practices will only have to worry about one of those codes.

Cyclocryotherapy--CPT code 66720 (Ciliary body destruction; cryotherapy)--now includes new moderate sedation codes 99143 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time) and 99144 (... age 5 years or older, first 30 minutes intra-service time).

Version 12.1 of the NCCI edits, effective April 1, marks this edit with modifier indicator "0," meaning that you cannot report 99143 or 99144 separately from 66720 under any circumstances.

Codes 99143 and 99144 describe "sedation services supervised or performed by the person doing the procedure," says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.

Check CPT Appendix G for Moderate Sedation Guidelines

Overall, 543 CPT codes now include 99143-99144 in unbreakable bundles. HCPCS and CPT coding manual guidelines conclude that moderate sedation is already an inherent part of all 543 procedures, NCCI says. The codes are specially marked in most CPT manuals, and they appear in Appendix G, "Summary of CPT Codes That Include Moderate (Conscious) Sedation."

"Since these services include moderate sedation, it is not appropriate for the same physician to report both the service and the sedation codes," the manual states.

Don't miss: NCCI 12.1 also makes 99143-99144 a component of nearly all of the evaluation and management service codes (99201-99357). The E/M bundles are marked with modifier indicator "1," permitting the use of a modifier to report the two codes separately when medically necessary.

The moderate sedation codes are part of a set of time-based codes that CPT introduced in 2006 to replace deleted codes 99141 and 99142. The deleted codes were also bundled into 66720.

Although Medicare never paid separately for 99141 and 99142, the new codes (99143-99150) have a status of "C," which means "carrier-priced." Providers should check with their Medicare Part B carriers for information on billing these codes.

Find out more: For all the NCCI edits, visit www.cms.hhs.gov/NationalCorrectCodInitEd/.