Ophthalmology and Optometry Coding Alert

With cataract: When your physician inserts the Xen stent in conjunction with a cataract procedure, submit Category III code 0449T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device) in addition to either 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis … manual or mechanical technique … without endoscopic cyclophotocoagulation) or 66982 (… complex …) for traditional or complex cataract surgery, respectively.

“Depending on the payer allowable, 0449T may be listed first before cataract surgery,” according to the Xen Gel Stent coding fact sheet (www.aao.org/Assets/bd71150c-c9ee-4622-be06-78eda413afa 7/637886642913100000/0449t-xen-gel-stent-fs-pdf?inline=1).

Stand-alone procedure: There are two ways to implant a Xen stent, and code selection is based on the surgical approach.

• If ab interno (from inside the eye), submit 0449T.
• If ab externo (from outside the eye), submit 66183 (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach).

When your provider inserts more than one Xen stent at the same time as the initial device, report add-on code +0450T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device …) for each additional stent. “No [relative value units] RVUs are assigned. Payment is at the payer’s discretion. No payment is made to the facility as it is bundled with the primary stent,” per the fact sheet.

Remember: For stent removals, report 65920 (Removal of implanted material, anterior segment of eye). If removed within the global period of the cataract surgery, append modifier 78 (Unplanned return to the operating/procedure room by the same physician … following initial procedure for a related procedure during the postoperative period). “Do not begin a new global period. Continue the 90-day postop from the original cataract surgery,” per the fact sheet.

Repositioning: If the surgeon repositions the stent, report 66999 (Unlisted procedure, anterior segment of eye).

Revision: When the ophthalmologist revises the Xen stent, submit 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) for bleb revision or 66999 for non-bleb related revisions, such as repositioning or trimming.