Ophthalmology and Optometry Coding Alert

Question: If I'm reporting a shunt procedure, can I code separately for the scleral patch graft? If so, which diagnosis code should I link it to?

New York Subscriber Answer: Use 67255 (Scleral reinforcement [separate procedure]; with graft) for the graft. The reason for the reinforcement is usually a sclera that is thin or weakened, sometimes from previous surgery. The ophthalmologist performs this when inserting the shunt (66180, Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]).

The shunt drains "some of the aqueous fluid from the anterior chamber into a reservoir beneath the conjunctiva, lowering the pressure in the eye," according to the CPT Assistant, August 2003. If the graft is done on the same day as the shunt, file 67255 appended with modifier -51 (Multiple procedures).

It's not medically necessary to perform 67255 on every patient who gets a shunt. Documentation should include information about the scleral thinning or other reason for the reinforcement procedure. Link the procedure to diagnosis code 379.19 (Other disorders of sclera; other), an open-ended code. Do not use the staphyloma code (66225, Repair of scleral staphyloma; with graft), which is for an infectious process.

- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla.; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.