Ophthalmology and Optometry Coding Alert

Also: New bundles affect your vitrectomy codingIf you were hoping to report anesthetic injections along with eye surgery codes and receive separate reimbursement, Medicare has bad news. The latest set of the Correct Coding Initiative (CCI) edits, version 14.3, leaves little doubt that Medicare is in the mood to bundle nerve blocks.CCI 14.3, which takes effect for dates of service beginning Oct. 1, 2008, bundles 64402 (Injection, anesthetic agent; facial nerve) into 163 eye surgery codes, joining 96 bundles already in place. The result: Code 64402 is now bundled into nearly all of  the eye surgery codes, meaning that CCI considers 64402 to be an inherent part of  those procedures.If you do report 64402 with an eye surgery code without modifiers, Medicare payers will only reimburse for the eye surgery code (the comprehensive code).Exceptions: Corneal procedures 65760 (Keratomileusis), 65765 (Keratophakia), 65767 (Epikeratoplasty), and 65771 (Radial keratotomy) are not included in these edits.Also excluded are unlisted-procedure codes 66999, 67299, 67399, 67599, 67999, 68399, and 68899; and add-on codes 66990, 67225, 67320, 67331, 67332, 67334, 67335, and 67340. But because you cannot report an add-on code without also reporting a primary code, and as most of the primary codes are now bundled with 64402, you also will not be able to report any of those add-on codes with 64402.CCI Blocks Out Drug AdministrationNothing new: In 2003, CCI 9.0 bundled nerve block codes 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) into most of the eye surgery codes --" with the exceptions of the corneal procedures, unlisted procedures, and add-on codes mentioned above.Why the exceptions? "It probably has to do with the reason why the facial nerve block is given and how the nerve block affects the muscles of the facial expression," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "Therefore, it is not likely that a nerve block would be used for the corneal procedures. That being said, I'm not sure why some of the other procedures would be included in the bundling edit."Background: Medicare has previously come down hard on other drug infusions and injections. In 2006, CCI 12.0 bundled drug administration codes 90760 (Intravenous infusion, hydration; initial, 31 minutes to one hour), 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour), 90772 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), 90774 (... intravenous push, single or initial substance/drug), and 90775 (... each additional sequential intravenous push of a new substance/drug [list separately in addition to code for primary procedure]) into most of the eye surgery codes.Most of these [...]