Ophthalmology and Optometry Coding Alert

Don't use an unlisted-procedure code for transciliary filtration--insurers now require this new code

If your ophthalmic surgeon performs transciliary filtration surgery on patients with intractable glaucoma, you'll be happy to see a new Category III code for this service in 2006.

CPT 2006 contains a new note under the current scleral fistulization codes, 66150-66172 (Fistulization of sclera for glaucoma ...), which directs you to 0123T (Fistulization of sclera for glaucoma, through ciliary body).

The FDA approved transciliary filtration (TCF) in October 2004. TCF, also known as "Singh filtration," is an alternative to trabeculectomy for phakic chronic open angle glaucoma patients. Ophthalmic surgeons use a plasma blade (called a Fugo blade) to incise a small opening in the sclera and ciliary body, allowing intraocular fluid to drain into the eye's lymphatic system.

Experts hail TCF as quicker than trabeculectomy, causing less bleeding and fewer postoperative complications. If the New Code Fits, Quit Reporting 66999 Since Category III codes are temporary national codes, Medicare does not assign them relative value units (RVUs) in the Physicians Fee Schedule. But don't be tempted to replace 0123T with an unlisted-procedure code (such as 66999, Unlisted procedure, anterior segment of eye) to report TCF: CPT rules direct that if a Category III code is available, you must report it instead of an unlisted-procedure code, says Mary Harper, CPC, coder and office manager for Hampton Roads Eye Associates in Newport News, Va.

Expert advice: Work with your ophthalmologist when negotiating with your carrier for reimbursement for 0123T, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. "I ask providers to determine what they feel is their cost to perform the procedure, which includes their expertise and work time," she says.
 
Don't just use an existing Category I code as a basis for comparison--for many CPT codes, "the RVUs assigned don't make any sense whatsoever for a lot of services," Mac says.

Eyeball the New Codes for Macugen, Retaane CPT 2006 introduces another new Category III code, 0124T (Conjunctival incision with posterior juxtascleral placement of pharmacological agent [does not include supply of medication]), to describe an experimental procedure in which the surgeon places a depot suspension of Retaane behind the globe, through a catheter passing through a conjunctival incision.

Some ophthalmic surgeons may soon be turning to anti-angiogenic therapy to treat macular degeneration. Ophthalmologists can insert a new drug, Retaane (anecortave acetate), behind the eye instead of directly into the eyeball.

The FDA has found Retaane to be "approvable," and the drug may be on the market soon.
 
Macugen (pegaptanib sodium), another drug often used to treat macular degeneration, gets a HCPCS code for the drug supply in 2006. Starting Jan. 1, report  J2503 (Injection, pegaptanib [...]