Ophthalmology and Optometry Coding Alert

Question: We’ve noticed that payment for 66720 (Ciliary body destruction; cryotherapy) has dropped this year and our carrier can’t explain why. Can you explain the problem?

Codify Subscriber

Answer: The pay cut that you discovered involves a change in the 2017 Medicare Physician Fee Schedule Final Rule that impacts codes that previously had moderate sedation payment bundled into them. You’ll note that the most recent edition of CPT^® has removed the “bull’s eye” symbol from 66720 and several other codes which no longer include conscious (moderate) sedation services.

Payment reduction:  Corresponding to those CPT^® code changes that remove moderate sedation services, you’ll see a payment reduction for those procedures on the Medicare Physician Fee Schedule (MPFS). For instance, payment for 66720 has decreased from $480.14 last year to $467.27 in 2017

Separate code is key: As of Jan. 1, you should be using a separate code in addition to the surgical procedure code if you need to document that your surgeon performed the moderate sedation associated with the procedure. If you fail to add the appropriate code, you stand to lose not only the income from the reduced payment for the surgical code, but the pay for the moderate sedation codes as well. Caution: If your surgeon doesn’t provide the sedation during the procedure, you essentially got paid for it anyway prior to Jan. 1. Now you can expect to earn less pay for the same service you performed last year.

Notice: CPT^® 2017 deletes all codes from Appendix G, which previously listed all codes that include moderate sedation. Instead, a new note directs coders, “For information/guidance on reporting moderate (conscious) sedation services with codes formerly listed in Appendix G, please refer to the guidelines for codes 99151, 99152, 99153, 99155, 99156, 99157.”