Ophthalmology and Optometry Coding Alert

The plus side: You can break these bundles using a modifier

Just when you've got all the new CPT codes and the January edition of the National Correct Coding Initiative (NCCI) edits under your belt, here comes round two of the NCCI edits.
 
Good news: We've done the work for you. Here is a rundown of the most important additions and deletions in version 13.1, which took effect on April 1.
 
"Of note is that all of the edits contain a '1' modifier, meaning it may be appropriate to 'unbundle' when appropriate (e.g., different eye, separate encounters)," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla.

Several Fistulation Codes Qualify as Mutually Exclusive

NCCI 13.1 bundles 0099T (Implantation of intrastromal corneal ring segments) into 65775 (Corneal wedge resection for correction of surgically induced astigmatism) with a modifier indicator of 1. CPT says that bundled procedure codes cannot be reported together because they are considered mutually exclusive of each other, meaning the procedure cannot reasonably be performed at the same anatomic site or at the same patient encounter.
 
You'll also have to incorporate new bundles for 0123T (Fistulization of sclera for glaucoma, through ciliary body). NCCI now bundles 0123T into these codes -- all with a modifier indicator of 1:

• 66150 -- Fistulization of sclera for glaucoma; trephination with iridectomy

• 66155 -- ... thermocauterization with iridectomy

• 66160 -- ... sclerectomy with punch or scissors, with iridectomy

• 66165 -- ... iridencleisis or iridotasis

• 66170 -- ... trabeculectomy ab externo in absence of previous surgery

• 66172 -- ... trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents).

"The edits make sense from a coding perspective, and I do not see any reason to raise an eyebrow with these edits," Mac says. "In fact, the CPT descriptor for code 66172 already contains a note to use 0123T for transciliary body sclera fistulization instead of 66172."
 
Last: The final mutually exclusive bundle to add to your list is 0124T (Conjunctival incision with posterior juxtascleral placement of pharmacological agent), which is bundled into 68200 (Subconjunctival injection) with a modifier indicator of 1.

Avoid Coding Blepharoptosis With Grafts

If you've reported 0099T (Implantation of intrastromal corneal ring segments) with 65772 (Corneal relaxing incision for correction of surgically induced astigmatism), you'll want to avoid doing so in the future. NCCI 13.1 bundles the two codes with a modifier indicator of 1.
 
The latest edits also bundle 0123T (Fistulization of sclera for glaucoma, through ciliary body) into 65850 (Trabeculotomy ab externo) and 66605 (Iridectomy, with corneoscleral or corneal section; with cyclectomy) with a modifier indicator of 1.
 
Caution: Logically, 20920 (Fascia lata graft; by stripper), 20922 (... by incision and area exposure, complex or sheet) and 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]) are now bundled into both 67901 (Repair of blepharoptosis; frontalis muscle technique with suture or other material [e.g., banked fascia]) and 67902 (... frontalis muscle technique with autologous fascial sling [includes obtaining fascia]) with a modifier indicator of 1.
 
"It makes sense to bundle the blepharoptosis codes with 20920, 20922 and 20926 because the latter codes are for grafts that are already included in the descriptor and payment of 67902, while 67901 uses suture or other material," Mac says.

Count Out Reporting Medicine Therapy and Eye Exams

If your opthalmologist performs medication therapy services, you'll want to watch out for a few new bundles. NCCI 13.1 now bundles 0115T (Medication therapy management service[s] provided by a pharmacist, individual, face-to-face with patient, initial 15 minutes, with assessment, and intervention if provided; initial encounter) and 0116T (... subsequent encounter) into:

• 92002 -- Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate,
new patient
• 92004 -- Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits
• 92012 -- Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
• 92014 -- Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits.

 Remember: You can tackle these new bundles using a modifier when appropriate since the bundles all have a modifier indicator of 1.