Ophthalmology and Optometry Coding Alert

Version 7.0 of the Correct Coding Initiative (CCI) has removed a bundle pursuant to a request by the American Academy of Ophthalmologists (AAO). Code 67038 (vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) is no longer a component of 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). This means that ophthalmologists will be paid separately for the epiretinal membrane stripping. The original inclusion of the bundle was said to be an error by HCFA.

Raequell Duran, president of Practice Solutions, a coding and reimbursement consulting company based in Santa Barbara, Calif., says the AAO met with HCFA years ago, and an agreement was made that there wasnt a code available besides 67038 to describe the work of the membrane stripping. Even though the descriptions for 67108 and 67038 describe vitrectomy, when billed together the service for the lower valued code, 67108, would be reduced by 50 percent because of the multiple procedures reduction payment rule. It was agreed that due to the inherent reduction in performing multiple procedures, the physician would not be paid twice for the vitrectomy work represented in both codes. It would be appropriate to code 67038 using the -51 modifier (multiple procedures) on the lower valued code.

No New Modifier -25 Bundles

A-scans and B-scans (76506-76536) remain bundled in the eye exam and evaluation and management (E/M) codes when performed on the same date of service. If a separately identifiable service is performed, you can be paid for the office visit in addition to the scan, providing you append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit.

There is a lot of confusion about the modifier -25 bundles released last fall, largely due to people generalizing the bundles for the A- and B-scans to all testing service codes when, in fact, other testing services were not included in the 7.0 update to the CCI. Visual fields (92081-92083) are not bundled into anything but each other, and do not require modifier -25 on the accompanying office visit. No other ophthalmological services are bundled into E/M or eye exam codes.