Ophthalmology and Optometry Coding Alert

Question: Which CPT code should we use for a scleral patch graft following aqueous shunt placement?

Illinois 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]). If the graft is done on the same day as the shunt, file 67255 with modifier -51 (Multiple procedures) appended. These codes are not bundled in the Correct Coding Initiative.
 
Its 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.
 
Use 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.

  Answers contributed by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; Dennis Sandoval, MD, Eye and Facial Surgery of New Mexico, Albuquerque; John Bell, CEO, Maine Eye Care, Waterville; and Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.