Ophthalmology and Optometry Coding Alert

Question: When our ophthalmic surgeon performs goniotomy in connection with the insertion of an aqueous drainage device into the trabecular meshwork, is it appropriate to report 65820?

Answer: No. Code 65820 (Goniotomy) is not typically reported in addition to other angle surgeries (e.g., 66989, 66991 (Extracapsular cataract removal with insertion of intraocular lens prosthesis … with insertion of intraocular (e.g., trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device ...)) or Schlemm’s canal implants (e.g., 0671T (Insertion of anterior segment aqueous drainage device into the trabecular meshwork …)).

In such cases, you should only report the applicable code describing the aqueous drainage device insertion (e.g., 66989, 66991, 0671T), as the device insertion includes the incision through the trabecular meshwork and, therefore, is incidental to the service performed. But “if extensive or multiple incisions larger than punctures of the trabecular meshwork are performed away from the drainage device and over an area of three or more clock hours, goniotomy may be reported,” according to CPT^® Assistant (August 2022).

“Goniotomy procedure performed in conjunction with the insertion of a glaucoma drainage device is considered not medically reasonable and necessary. Routine performance of goniotomy with insertion of a glaucoma drainage device may be subject to focused medical review,” per Local Coverage Determination (LCD) L38233, Micro-Invasive Glaucoma Surgery (MIGS).