Ophthalmology and Optometry Coding Alert

Don't let post-op procedures, materials complicate coding Less common than typical glaucoma treatments such as trabeculectomy, drainage devices like the aqueous shunt can be a last defense against blindness and a rare challenge for coders - but coding aqueous shunts doesn't have to be a drain on
your reimbursement.
 
The procedure is rare, performed about 5,000 times per year, most likely because of its complexity, says Donna McCune, CCS-P, with Corcoran Consulting Group in California.
 
Code 66180 (Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]) is the descriptor for a device that drains "some of the aqueous fluid from the anterior chamber into a reservoir beneath the conjunctiva, lowering the pressure in the eye," according to the CPT Assistant, August 2003. Connect Aqueous Shunt Procedure Codes to Several Types of Glaucoma The procedure is associated with the following indications:
    neovascular glaucoma
    glaucoma associated with uveitis
    glaucoma associated with iridocorneal endothelial (ICE) syndrome
    eyes with previous scarring from ocular surgery or trauma
    vitreoretinal (retinal detachment surgery) with glaucoma
    penetrating keratoplasty (corneal transplant) with glaucoma
    pediatric glaucoma
    glaucoma associated with anterior segment malformations. Use Modifier -51 for Multiple Procedures If your surgeon performs a sclerectomy in addition to a shunt procedure (66160, Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy), don't bill these separately, says Paula Thomas, CPC, billing specialist for Southeastern Retina Associates in Tennessee. NCCI bundles 66160 and 66180.
 
The shunt procedure may also require that the ophthalmologist perform a scleral patch graft (67255, Scleral reinforcement [separate procedure]; with graft) during the same surgical session.
 
The reason for the reinforcement is usually a sclera that is thin or weakened, sometimes from a previous surgery. The ophthalmologist performs this when inserting the shunt. If the graft is done on the same day as the shunt, report 67255 and append modifier -51 (Multiple procedures).
 
These codes are not bundled in the National Correct Coding Initiative, so carriers should reimburse you separately for these services. Modifier -51 indicates that "multiple procedures, other than E/M services, are being performed at the same session by the same provider ... the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier -51 to the additional procedure or service code(s)."
 
For example, if the procedures were done on the left eye, the form would look like this: 66180-LT on the first line, and 67255-51-LT on the second line.
 
Performing 67255 isn't medically necessary on every patient who gets a shunt. Documentation should include information about the scleral thinning or another reason for the reinforcement procedure.
 
For example, use 379.19 (Other disorders of eye; other disorders of sclera; other), an open-ended code. Change Manuals [...]