Ophthalmology and Optometry Coding Alert

Question: For the use of silicone oil, we have always used 67025 (injection of vitreous substitute, pars plana or limbal approach, [fluid-gas exchange], with or without aspiration [separate procedure]). Is there a code to charge for the oil itself? Is there a code for the removal of silicone oil, if it becomes necessary?

Florida Subscriber

Answer: In your example, the practice expense of the vitreous substitute (the silicone oil) is included in the reimbursement for the code 67025. When performed in an outpatient or ambulatory surgical center (ASC), the code is assigned an ASC facility group that also includes the cost of the oil. When billing for the removal of the oil you need to select the code that describes how the removal was performed. For example, if a pars plana vitrectomy was performed to remove the oil, then 67036 (vitrectomy, mechanical, pars plana approach) should be used to bill the service. Although 67036 reflects most closely what is done surgically, it is controversial.
There are many retinologists who believe the work involved in removal is so insignificant that they do not bill at all. If they think 67036 is too much, they can always use the -52 modifier for a reduced service with a fee they believe more closely fits the work involved. There is a code that is often used in error, 67121 (removal of implanted material, posterior segment; intraocular). This code was designed for the retrieval of a posteriorly dislocated IOL and should not be used for the removal of silicone oil.

Answers to You Be the Coder and Reader Questions contributed by: Raequell Duran, president, Practice Solutions, a coding, compliance and reimbursement consulting firm specializing in ophthalmology, Santa Barbara, Calif.; Lise Roberts, vice president, Health Care Compliance Strategies, a compliance and coding consulting company, Jericho, N.Y.; Catherine Brink, CPC, CMM, president, Healthcare Resource Management, Inc., a coding, compliance and reimbursement consulting company, Spring Lake, N.J.; Patricia Salmon, a coding, compliance and reimbursement consultant, Newtown Square, Pa.