Ophthalmology and Optometry Coding Alert

The new edits may also prevent you from separately reporting injection G codes ever again While your ophthalmologists are tightening up eyelids, NCCI is tightening up entropion and ectropion coding. Starting in July, you'll have to think twice if you want to report canthopexy along with several common eyelid repair codes - and the new bundles could mean a loss of up to $468 per procedure.
 
Here's the inside scoop on the National Correct Coding Initiative edits, version 11.2, and how you can stay in the good graces of the bundling overlords. Bundle Canthopexy With Ectropion, Entropion Repair Many eyelid surgeries involve work on the canthus, the meeting of the upper and lower eyelids in the corner of the eye. NCCI 11.2 bundles CPT code 21280 (Medial canthopexy [separate procedure]) into four procedures:
   67916 - Repair of ectropion; excision tarsal wedge
   67917 - ... extensive (e.g., tarsal strip operations)
   67923 - Repair of entropion; excision tarsal wedge
   68720 - Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity). The new edits also bundle 21282 (Lateral canthopexy) into 67916 and 67923. Those tarsal wedge excision codes also now include 67950 (Canthoplasty [reconstruction of canthus]) - both of which are now bundled into 21280 and 21282. All of these bundles appear with modifier indicator "1," which means Medicare will allow you to report the two codes together with modifier 59 (Distinct procedural service) if the clinical circumstances and documentation warrant it, says Sheryl Faison, CPC, inpatient coder for the department of ophthalmology at the University of North Carolina School of Medicine in Chapel Hill.
 
Canthoplasty (reinforcing the lower eyelid by cutting apart and repositioning the lateral canthal tendon) and canthopexy (placing a single suture in the canthus to reinforce the eyelid) are both often components of blepharoplastic surgeries, including ectropion and entropion repair. Ophthalmology practices rarely report 21280 or 21282 as separate procedures, says Vicky Murphy, CPC, coder and billing manager for Lake Eye Associates in Eustis, Fla.
 
Code 68720 is now mutually exclusive with 31239 (Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy), states NCCI 11.2. If you report the two together without a modifier, Medicare carriers will only pay for the procedure in column 1 of the edits, Faison says. Usually, as is the case with 68720, the lower-paying code is in column 1, she says - Medicare does this to discourage coders from improperly breaking mutually exclusive bundles. Include Drug Administration in Most Procedures  
Watch where you stick those injection G codes: NCCI 11.2 bundles three of them into virtually every eye procedure in the CPT manual.
 
NCCI also dictates that you will no longer be able to report G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), G0353 (Intravenous push, single [...]