Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performed both canaloplasty and goniotomy on a patient’s right eye to treat their worsening glaucoma. We reported CPT^® code 66174 for the therapeutic dilation of Schlemm’s Canal and 65820 for goniotomy, but the claim was denied. Where did we go wrong?

New Jersey Subscriber

Answer: The problem likely stems from the fact that as of July 1, 2020, 65820 (Goniotomy) is bundled with 66174 (Transluminal dilation of aqueous outflow canal; without retention of device or stent). When these procedures are performed during the same session, only 66174 (canaloplasty) should be reported, as the incision inherent in goniotomy is incidental to 66174, according to the December 2018 CPT^® Assistant.

CPT^® Assistant addressed this issue again in May 2022, stating that “… because the procedure described by code 65820 is considered an inherent component of code 66174, these procedures should not be reported together … When these procedures are performed during the same session, only code 66174 should be reported because this procedure includes incising through the trabecular meshwork, which is a goniotomy.” Therefore, you should not report 65820 separately in conjunction with 66174.

To provide clarity when reporting these services, the CPT^® 2022 code set added a new parenthetical instructional note following 66174 to restrict reporting 66174 with 65820.