Ophthalmology and Optometry Coding Alert

Skipping these 26 and TC rules could be costing you $30 per patientRetinal coders, take note: The latest version of Correct Coding Initiative (CCI) edits adds to the list of CPT codes you cannot report with certain retinal detachments.Effective July 1, CCI places lens extraction codes 66920 (Removal of lens material; intracapsular), 66930 (... intracapsular, for dislocated lens) and 66940 (... extracapsular) into a Column 1/Column 2 edit with retinal detachment repair code 67108 (Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique).Code 67108 is the Column 1 procedure in these edits, meaning that CCI views it as a comprehensive procedure that already includes the work described by 66920-66940. Lensectomy codes 66840-66852 (Removal of lens material ...) are already bundled with 67108, thanks to previous CCI edits.Don't miss: Retinal detachment repair code 67113 (Repair of complex retinal detachment ...), introduced in CPT 2008, also includes lensectomy and lens extraction codes 66840-66940.As of July 1, CCI considers cataract surgery codes 66982-66984 included in 67108. The cataract codes are also components of 67113. Last April's CCI deleted the bundles including 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) and 66986 (Exchange of intraocular lens) in 67113, however, and CCI does not bundle those codes into 67108. (For more information, see "Bundling Cataract Removal and Trabeculotomy? Not Anymore" in Ophthalmology Coding Alert Vol. 11, No. 5.)CCI has marked all of these bundles with modifier indicator "1," which, as a rule, means that you can override the edits with modifier 59 (Distinct procedural service) in appropriate circumstances, says Vicky Varley O'Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis.Blepharoptosis Repair Now Includes Visual FieldsBecause visual field tests are usually necessary for blepharoptosis patients to document how much the drooping eyelids are impairing vision, you may be startled to see a new bundle in CCI version 14.2 including 92081-92083 (Visual field examination, unilateral or bilateral, with interpretation and report) in 67901-67908 (Repair of blepharoptosis).CCI marks these bundles with modifier indicator "0," meaning that you cannot report a 9208x code with a 6790x code under any circumstances.Not so fast: Keep in mind that these edits only prevent you from reporting visual fields performed on the same day as blepharoptosis repair, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. Because most patients undergo the visual field testing before the surgery, you should have no problem reporting the tests separately."Most practices do the visual fields, and then the physician reviews the results and decides to schedule the repair. [...]