Ophthalmology and Optometry Coding Alert

Question: When a surgeon performs an aqueous shunt procedure (66180) along with a scleral reinforcement with graft (67255), what is the best way to code so that both procedures are reimbursed?

OPC Subscriber

Answer: We talked to Linda Yocum, surgical biller for Retina and Oculoplastic Consultants, a four-physician practice in Camp Hill, PA. I bill the two procedures together, with the -51 modifier on the second code and the eye modifier (-LT or -RT) on both, says Yocum.

Modifier -51 indicates that multiple procedures are being performed other than E/M services, at the same session by the same provider ... the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier -51 to the additional procedure or service code(s) ... Note: This modifier should not be appended to designated add-on codes, according to CPT.

Yocum uses 66180 as the first procedure on the claim, which she files electronically. For example, if the procedures were done on the left eye, the form would look like this: 66180-LT on the first line, and 67255-51-LT on the second line. These two procedures have been done together four times in the past year and a half at Yocums practice. In two cases, the payer was Medicare; in the third, Blue Cross; and in the fourth, an HMO. All three payers accepted Yocums coding for the procedures. And, she adds, no doctors notes have been requested for this combination of procedures.

It seems as if we should be able to get paid for the device for the shunt as well, but we dont file for it, says Yocum. The HCPCS code for the aqueous shunt is L8612.