Ophthalmology and Optometry Coding Alert

Question: A patient has a trabeculoplasty (CPT 65855 ), and at the same time, the patient has a gonioplasty in the same eye. Would you please advise on how to code for maximum reimbursement? The patient has glaucoma (365.11).

Julia Bannan, Office Manager
Raymond A. Bannan, MD
Wheeling, WV

Answer: The gonioplastywhich does not have a CPT code but can be coded a number of waysis most likely bundled with the trabeculoplasty. (Gonioplasty has no code because usually it is done with something else. It becomes a part of that procedure because it has to be done in order to do the other procedure properly.) Codes that are bundled with 65855 include goniotomy (65855)and a gonioplasty is like a goniotomy, done with a laser.

Other bundled codes with trabeculoplasty are 65850 (trabeculotomy ab externo), 65860 (severing adhesions of anterior segment, laser technique [separate procedure]), 66170 (fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery), 67250 (scleral reinforcement [separate procedure]); without graft), 67500 (retrobulbar injection; medication [separate procedure, does not include supply of medication]), 92020 (gonioscopy [separate procedure]), and 92504 (binocular microscopy [separate diagnostic procedure]).

Both the gonioplasty and the trabeculoplasty are done for the same reason (glaucoma). You will not get paid for both, however, so it is important to put the code with the highest reimbursement rate as the first procedure code.

Note: Some practices charge 66762 (iridoplasty by photocoagulation [one or more sessions] [e.g., for improvement of vision, for widening of anterior chamber angle]) for the gonioplasty. Do not use this code for gonioplasty; it is not correct.