Ophthalmology and Optometry Coding Alert
Don’t Unbundle Due To Treatment of Contiguous Structures
Question: When our surgeons perform mechanical vitrectomy and prophylactic photocoagulation simultaneously, can I bill both and use modifier 59 to unbundle 67036 and 67145? New Mexico Subscriber Answer: No. The National Correct Coding Initiative (NCCI) edits bundle 67145 (Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation) with 67036 (Vitrectomy, mechanical, pars plana approach). However, CPT® does contain a single code for vitrectomy performed to address a retinal detachment, and it includes the laser: 67108 (Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy …). This would be the code to use in scenarios such as the one you describe.
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Don’t Unbundle Due To Treatment of Contiguous Structures
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