Ophthalmology and Optometry Coding Alert

Question: We are confused about whether we can report 66180 (Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft) and 67255 (Scleral reinforcement [separate procedure]; with graft) together. We’ve heard differing advice about these services. Can you share some details about billing these together?

Codify Subscriber

Answer: Your confusion is understandable, considering that the National Correct Coding Initiative (NCCI) does bundle these two services together, but includes a “1” modifier on the edit, which indicates that you can use a modifier to separate the bundle. However, it would be extremely rare – and nearly impossible -- to be able to report these services together.

In fact, a parenthetical note directly below the descriptor for 66180 in the CPT^® manual states, “Do not report 66180 in conjunction with 67255.” In addition, the American Academy of Ophthalmology states on its website, “The two procedures are bundled and should not be billed the same day. You should only submit CPT^® code 66180, which includes the graft.”

It’s unclear why the NCCI edits suggest that a modifier is appropriate in separating this bundle, but your best bet is to follow the AMA CPT^® bundling rules, as well as the AAO guidance, and avoid reporting these services together since the work described by 67255 is already included in the descriptor for 66180.