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Ophthalmology and Optometry Coding Alert

NCCI Update:

Brace Yourself for More PDT, FA Bundles

Published on Sat Mar 12, 2005

Reporting injections separately will get you nowhere with Medicare

If you're thinking about billing some of the new drug injection G codes along with fluorescein angiography, think again - thanks to the latest version of the National Correct Coding Initiative edits, which take effect April 1. Here's the skinny on how the changes will affect your FA claims and how you code for photodynamic therapy and ocular surface reconstruction.

Include Infusion in Photodynamic Therapy

The second set of NCCI edits for 2005, version 11.1, clarifies how coders should use HCPCS code G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]). NCCI 11.1 bundles that code into 67221 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photodynamic therapy [includes intravenous infusion]) due to "HCPCS/CPT procedure code definition." Note that the descriptor for 67221 contains the phrase "includes intravenous infusion."

Key: The previous set of NCCI edits, released in January 2005, bundled HCPCS code G0353 (Intravenous push, single or initial substance/drug) into 67221. Since G0354 is meant to report an additional intravenous push, you should not bill it without also billing G0353, says Meladie Heinz, CPC, insurance and coding specialist for Eye Center of Colorado West in Grand Junction. And since G0353 and 67221 are bundled, you couldn't report G0354 with 67221 even before this coding edit. By bundling G0354 into 67221, NCCI is continuing to clarify that the procedure includes all intravenous infusion.

CPT code 67221 has also included HCPCS codes 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) since last January.

This should not be earth-shattering news to ophthalmology coders, Heinz predicts. "Those are not codes we would have ever billed to begin with," she says. "The IV infusion codes are more for chemotherapy."

Don't miss: NCCI 11.1 also bundles G0354 into 92230 (Fluorescein angioscopy with interpretation and report), 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report]), 92240 (Indocyanine-green angiography [includes multiframe imaging] with interpretation and report) and 92287 (Special anterior segment photography with interpretation and report; with fluorescein angiography). All four of those CPT codes already include G0353.

The new bundles catch up with 92018 (Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete) and 92019 (... limited) by bundling them with G0353 and G0354 - as well as G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

Exclude Keratoplasty From Membrane Transplant

Other new bundles to take note of:
 

  •  Code 65780 (Ocular surface reconstruction; amniotic membrane transplantation) is mutually exclusive with 65710 (Keratoplasty [corneal transplant]; lamellar), 65730 (... penetrating [except in aphakia]), 65750 (... penetrating [in aphakia]), 65755 (... penetrating [in pseudophakia]), 65781 (Ocular surface reconstruction; limbal stem cell allograft) and 65782 (... limbal conjunctival autograft [includes obtaining graft]). If you attempt to bill 65780 with any of those codes, Medicare will only reimburse you for the lesser valued of the two.
     
  •  65781 is now mutually exclusive with 65710, 65730, 65750, 65755, 65780 and 65782.
     
  •  65782 is now mutually exclusive with 65710, 65730 and 65780.
     
  •  67250 (Scleral reinforcement [separate procedure]; without graft) is now included in 65780, 65781 and 65782 because of the HCPCS/CPT "separate procedure" definition.
     
  •  92504 (Binocular microscopy [separate diagnostic procedure]) is also included as a component of 65780, 65781 and 65782 due to "standards of medical/surgical practice."
     
  •  67950 (Canthoplasty [reconstruction of canthus]) now includes 21282 (Lateral canthopexy).

    Note: For a view of the new NCCI edits, see "Quick Key: Get the NCCI 11.1 Lowdown Here" later in this issue..

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