Ophthalmology and Optometry Coding Alert

Question:  Our physician used a Xen Gel implant on a glaucoma patient. Should I bill 66183 and 0449T together? Or should I bill just one or the other?

Wisconsin Subscriber

 Answer: A clearer understanding of the distinctions between the two codes you’ve listed might be helpful.

Code 66183 (Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach) describes a modification of a trabeculectomy procedure for treating medication–refractory IOP in glaucoma patients. This procedure is accomplished by creating a scleral flap in the first step and implanting a device in the second step, followed by closure of the flap as a watertight seal.

You would use Category III code 0449T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device) when your physician implants an aqueous drainage device, such as a Baerveldt^® glaucoma implant or an Ahmed® glaucoma valve, into the interior of the eye by means of a fornix- or limbus-based corneal incision. The device facilitates drainage into the space under the conjunctiva (the interior lining of the eyelids and external lining of the eyeball). No reservoir is implanted as part of this procedure.

What to report: What’s key here is the approach and the location of the device insertion. Since this isn’t spelled out in the procedure information you provide, consider the following general advice:

• For an external approach in the anterior segment, report code 66183.
• For an internal approach into the subconjunctival space, report 0449T.

Procedure edit pairing: Correct Coding Initiative (CCI) edits list 0449T as a Column 2 code for 66183, with a modifier allowed to differentiate between the services provided during the same operative session. If your documentation supports reporting both procedures on the same eye, you can append modifier 59 (Distinct procedural service) to code 0449T to override the edit.

On the other hand: If your physician performed one procedure (66183) on one eye and the other one (0449T) on the other eye, you can report both codes, appending modifiers LT (Left side) and RT (Right side) to distinguish laterality.

Final word: Code 0449T is a Category III temporary code, designated for data collection for emerging technologies, services, and procedures. If a Category III code is available, you must report it instead of a Category I unlisted code.