Ophthalmology and Optometry Coding Alert

Question: We used to report 66180 when the ophthalmologist implanted a mini aqueous shunt to treat glaucoma. I recently heard of a new code, 0192T, for the mini shunt, but our payer denied the claim. Is that the correct code?South Carolina SubscriberAnswer: Effective July 1, 2008, the AMA CPT panel introduced a new Category III code, 0192T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach), to describe insertion of the mini shunt without an extraocular reservoir. Code 66180 (Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]) describes a shunt with an extraocular reservoir. Ophthalmologists use these shunts to treat glaucoma, relieving pressure in the anterior chamber.Along with 0192T, CMS change request 1560 also introduced 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach) to the fee schedule, describing a mini shunt inserted through an internal approach. CR 1560 did not set any national RVUs for either 0191T and 0192T, indicating that they would be carrier-priced.Snag: Some carriers -- including Palmetto GBA, the Part B carrier for South Carolina, Ohio and West Virginia -- have issued local coverage decisions (LCDs) adding 0191T and 0192T to their non-covered lists. Another carrier, TrailBlazer (Delaware, the District of Columbia, Maryland, Texas and Virginia), added the codes to its "Investigational, Unproven or Experimental" listing.Carriers vary: CIGNA (Idaho, North Carolina and Tennessee) has indicated it will cover 0192T, but notes that 0191T "is currently undergoing clinical trials and is considered experimental/investigative, and therefore, not covered by Medicare at this time."Medicare may cover the external approach device (0192T) as long as the device is FDA-approved (for example, the Ex-PRESS mini shunt from Optonol). Some devices may not yet be FDA-approved.Best bet: Keep checking local coverage determinations for further instructions or updates on these two new Category III codes. Until that time, it may be appropriate to continue billing CPT code 66180 (Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]) for the FDA approved external approach devices.