Ophthalmology and Optometry Coding Alert

On Oct. 1, you'll code lesion and pterygium excisions differently In January 2004, CPT added the surgical code 68371 (Harvesting conjunctival allograft, living donor). The last set of NCCI edits for 2004, version 10.3, includes major changes to how you can report that code along with several lesion and pterygium excision and conjunctivoplasty codes.

Beginning Oct. 1, 2004, the National Correct Coding Initiative (NCCI) will bundle the fee for 68371 into the following procedures:

 65400 - Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

 65426 - Excision or transposition of pterygium;  with graft

 68320 - Conjunctivoplasty; with conjunctival graft  or extensive rearrangement

 68326 - Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement

 68335 - Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft). Translation: If you're reporting any of the procedures listed above, as of Oct. 1 you can no longer report 68371 as a separate procedure.

The new bundling is somewhat mystifying, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif., especially since 68371 is only a few months old. "They created a code to reimburse the physician for obtaining the graft," Duran says, "and now they are bundling it into the procedures they need the graft for."

But many oculoplastics coders are already including graft harvesting in their conjunctivoplasty procedures. "We've never reported [68371] separately in addition to conjunctivoplasty," says Ruby Ball, patient accounts supervisor for Visions, an oculoplastics practice in Las Vegas.

The 68371 bundles are all marked with a status indicator of "1," which indicates that you can break the bundle with a modifier and report the two codes together when you have the appropriate circumstances and documentation to do so.

There's more: NCCI 10.3 also bundles 68320 (Conjunctivoplasty; with conjunctival graft or extensive rearrangement) and 65780 (Ocular surface recon-struction; amniotic membrane transplantation) into procedures 65420 (Excision or transposition of pterygium; without graft) and 65426 (... with graft).

Watch out: All codes for initial and follow-up inpatient consultations (99251-99263) are becoming components of observation or inpatient hospital care codes 99234-99236. In other words, you can no longer bill for a consult if the physician also placed the patient under observation or admitted him as an inpatient on the same day, Duran says.

Further, you can't override these edits using a modifier - these bundles are marked with a status indicator of "0," which indicates that you may not bill them separately under any circumstances.