Ophthalmology and Optometry Coding Alert
Reader Question ~ Choose Category III Code for TCF
Choose Category III Code for TCF Question: My ophthalmologist performed a procedure he described as "used a Fugo blade to incise a small opening in the sclera and ciliary body, allowing intraocular fluid to drain into the eye's lymphatic system." Should I report this procedure using 66150? Maine Subscriber CPT 2006 contains a new note under the current scleral fistulization codes, 66150-66172, which directs you to 0123T (Fistulization of sclera for glaucoma, through ciliary body). Don't substitute: Since Category III codes are temporary national codes, Medicare does not assign them relative value units in the Physician Fee Schedule. But don't be tempted to replace 0123T with an unlisted-procedure code (such as 66999, Unlisted procedure, anterior segment of eye) to report TCF: CPT rules direct that if a Category III code is available, you must report it instead of an unlisted-procedure code. Caution: Your local Medicare carrier has discretion as to the coverage and allowed amount for Category III codes. Because it's a Category III service, your carrier may consider the procedure experimental and may not cover it. You may want to have the patient sign an advance beneficiary notice (ABN) to ensure you receive payment.
Answer: No. Code 66150 (Fistulization of sclera for glaucoma ...) is not the most appropriate code for the procedure your physician describes. The procedure described is called transciliary filtration (TCF), also known as "Singh filtration."
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