Bundling Cataract Removal and Trabeculotomy? Not Anymore
Published on Thu Apr 24, 2008
Plus: You can start reporting the new retinal detachment repair code with IOL insertionsGood news, ophthalmology coders: The next version of Correct Coding Initiative edits will not add any new bundles to your coding burden. In fact, CCI version 14.1 eliminates some bundles that may have been troublesome for you.Effective April 1, CCI deletes the bundle pairing 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) with 65850 (Trabeculotomy ab externo). You may now report the two services together for the same patient on the same day, when the ophthalmologist performs them both.Ophthalmologists sometimes combine cataract removal with trabeculotomy for patients with both cataracts and glaucoma.Key: On the other hand, CCI 14.1 does not free you to report 65850 with complex cataract removal code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage).Code 65850 remains bundled into 66982 with a "1" modifier indicator, which means you may report the two codes separately under the appropriate circumstances (for example, different eye, separate surgical session, etc.), says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.(For more information on complex cataract procedures, see "When Is Cataract Removal 'Complex'?" on page 35.)Don't miss: CCI also still bundles 65850 with the following:• 65855 -- Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)• 66172 -- Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)• 66711 -- Ciliary body destruction; cyclophotocoagulation, endoscopic.Include IOLs in Retinal RepairsCCI 14.1 also deletes a bundle that affected the new retinal repair code introduced in CPT 2008 (67113, Repair of complex retinal detachment [e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees], with vitrectomy and membrane peeling, may include air, gas or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling and/or removal of lens).As of April 1, CCI will no longer bundle 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) or 66986 (Exchange of intraocular lens) with 67113.CPT established 67113 to "report repair of complex retinal detachment that involves a vitrectomy with the removal of a neovascular membrane from the subretinal space," according to CPT Changes 2008: An Insider's View. Coders welcomed the addition, says [...]
