Ophthalmology and Optometry Coding Alert

The CPT Editorial Panel has answered ophthalmology coders' call for a code to describe diagnostic endoscopic-assisted procedure, but the new code will present its own set of challenges.

The release of CPT 2003 in November brought few, but important changes for ophthalmology coders. Most notably, the new add-on code, 66990, has been inserted under the Anterior Segment category of CPT 2003's Eye and Ocular Adnexa procedures section.

As an add-on code, +66990 (Use of ophthalmic endoscope) must be listed in addition to the code for the primary procedure but beware the indicated codes designated as appropriate primary procedures to use with 66990: 65820 Goniotomy 65875 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae 65920 Removal of implanted material, anterior segment of eye 66985 Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal 66986 Exchange of intraocular lens 67038 Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping 67039 ... with focal endolaser photocoagulation 67040 ... with endolaser panretinal photocoagulation. The addition of 66990 to the ophthalmology codes will be particularly useful for the repositioning of an intraocular lens when, for example, an endoscope is reinserted to make certain the patient has adequate capsular support for the newly implanted lens, William Rich III, MD, secretary of federal affairs for the American Academy of Ophthalmology and clinical instructor in ophthalmology at Georgetown University Hospital, told a gathering at the AAO/PAAO 2002 Joint Meeting in Orlando, Fla. One drawback of the new ophthalmic add-on code is that it cannot be used with 66710 (Ciliary body destruction; cyclophotocoagulation). AAO sources say pressure will be applied to the CPT Editorial Panel to take into account the need for a code addressing the secondary use of an endoscope with cyclophotocoagulation. Avoid Using Modifier -63 With Goniotomy Another new CPT modification that may affect ophthalmology coding is the addition of modifier -63 (Procedure performed on infants less than 4 kg). CPT 2003 guides coders to append this modifier when "procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician work commonly associated with these patients."

According to CPT 2003, modifier -63 can never be appended to goniotomy code 65820. The rationale for designating 65820 modifier -63-exempt is that "the additional work that modifier '-63' is intended to represent has been previously identified as an inherent element" within the procedure. CPT guidelines state further, "Modifier -63 was established to be appended only to invasive surgical procedures, and reported only for those for neonates/infants up to the 4-kg cut-off. In this population of patients there is a significant increase in [...]