Ophthalmology and Optometry Coding Alert

Okay, maybe not everything, but the latest version of the National Correct Coding Initiative's (NCCI) most widespread change likely to affect ophthalmologists is the bundling of medical nutrition therapy (MNT) into several E/M and Medicine section CPT codes and even some fellow G-codes.

NCCI Version 9.2, which went into effect July 1, bundles G0270 (Medical nutrition therapy; reassessment and subsequent intervention[s] following second referral in same year for change in diagnosis, medical condition or treatment regimen [including additional hours needed for renal disease], individual, face to face with patient, each 15 minutes) and G0271 (Medical nutrition therapy; reassessment and subsequent intervention[s] following second referral in same year for change in diagnosis, medical condition, or treatment regimen [including additional hours needed for renal disease], group [2 or more individuals], each 30 minutes) into general ophthalmological services codes 92002-92014 and most E/M codes.

If your ophthalmologist provides a comprehensive established patient eye exam (92014, Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) for a diabetic Medicare patient, and he also provides an initial medical nutritional therapy service (G0270) during that same visit, then you cannot separately report G0270.

Remember the rules about "bundled" codes: A bundle is the commonly used term to describe a pair of codes, one of which represents the comprehensive code and the other is the component code. NCCI considers the service represented in the component code included in and not separately billable from the service represented by the component code. NCCI outlines the rationale for bundling component codes into comprehensive codes:
   The included (or bundled) service represents the standard of care in performing the overall service (the comprehensive code).
   The included service is necessary to successfully accomplish the comprehensive procedure; failure to perform the component procedure may compromise the success of the procedure.
   The component code does not represent a separately identifiable procedure unrelated to the service represented by the comprehensive code.