Ophthalmology and Optometry Coding Alert

Question: Medicare no longer accepts the CPT code that we have used for years for a laser suture lysis (66999, Unlisted procedure, anterior segment of eye). What other ophthalmology CPT code could we use?

Louisiana Subscriber

Answer: You may have heard that some coders bill for the removal of sutures by using 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) with modifier -78 (Return to the operating room for a related procedure during the postoperative period). Even though some carriers may pay for this, it is not correct coding and should be discouraged.

Suture removal during the postoperative period should not be billed to Medicare because of Medicare's definition of the global surgical package. The Medicare Claims Processing Manual (chapter 12, section 40.1) states that the global package includes miscellaneous services: "Items such as dressing changes; local incisional care; removal of operative pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints." For ophthalmology, this includes suture removal by any method. Therefore, you should not bill separately for suture removal by laser lysis or any other method, regardless of whether the patient is in or out of the postoperative period.

Exception 1: If the patient is under general anesthesia for the suture removal, you may report 92018 (Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete) or 92019 (... limited).

Exception 2: When removing sutures after kerato-plasty for a patient insured by Medicare in southern California (National Heritage Insurance Company), you can bill the suture removal with CPT code 66999, listing the condition of keratoplasty in the comments section of the claims form.

See NHIC's Eye Care Billing Manual at http://www.medicarenhic.com/cal_prov/billing/eye_bill.pdf.