Ophthalmology and Optometry Coding Alert

The new National Correct Coding Initiative (NCCI) edits include only one coding change for ophthalmologists, but it could be an expensive one.
 
Revision or repair code 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) is now bundled into 66172 (Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma [includes injection of antifibrotic agents]).
 
Previously, physicians could report to Medicare both the trabeculectomy and the revision or repair of the operative wound, which may have been necessary due to  scarring that resulted from previous surgery. Now the repair is bundled into the surgical procedure.
 
The revision could cost ophthalmology practices as much as $262.50, 50 percent of the allowable of $515 when performed as a multiple procedure, according to the CMS relative value scale. For 66250, the fee is $515, nearly 50 percent of the fee for 66172 - $1,131.15. For private carriers, review their specific policies. 
 This revision, appearing in the NCCI edits, version 9.3, takes effect on Oct. 1, 2003, and runs through
Dec. 31, 2003.