Ophthalmology and Optometry Coding Alert

The latest round of bundling targets many of the new eye surgery codesWith more than 10,000 changes, you could spend hours weeding through the latest round of Correct Coding Initiative (CCI) edits. But we've already done the deciphering for you. Take a look at the ophthalmology edits you need to incorporate into your coding this year.Count More Than 35 Other Codes With 67041If your ophthalmologist performs retina surgeries, you welcomed the new vitrectomy codes with open arms in January. CCI hits these new codes hard in version 14.0, however.The latest CCI update bundles new vitrectomy code 67041 (Vitrectomy, mechanical, para plana approach; with removal of preretinal cellular membrane [e.g., macular pucker]) with 67030 (Discission of vitreous strands [without removal], pars plana approach) and 67031 (Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery [one or more stages]). The edit indicates that CCI now considers these codes mutually exclusive.Good news: Both bundles have a modifier indicator of 1, which means you can bypass an edit using a modifier under the appropriate circumstances, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "In general, these circumstances relate to separate patient encounters, separate anatomic sites (e.g., right eye and left eye) or separate specimens. For ophthalmology services, most edits with a modifier indicator of 1 allow reporting of the two bundled services when one service is performed on one eye and a CCI-bundled service is performed on the contralateral eye."During the procedure described with 67041, the ophthalmologist removes the central vitreous and shaves the vitreous "as close as is safe to the vitreous base while replacing the vitreous with a fluid to maintain intraocular pressure," says Regan Bode, CPC, CPC-EM, ACS-EM, OCS, product manager for Custom Coding Books in Seattle and founder of Eyecoding.net. "Since this code includes removing the vitreous already, it seems appropriate that other codes for removing or dissecting small areas or amounts of vitreous are bundled within 67041."In addition: CCI also bundles 67041 with 36000, 36410, 37202, 62318, 62319, 64415-64417, 64450, 64470, 64475, 65800-65815, 66830, 66840, 66852-66940, 67005-67028, 67036, 67101-67107, 67110-67112, 67120-67145, 67500, 67515, 68200, 69990, 90760, 90765, 90772, 90774 and 90775. All of these bundles have a modifier indicator of 1 except the bundle between 67041 and 69990. That bundle's modifier indicator is 0, which means you can never bypass the edit and separately report the bundled services, Mac says."Keep in mind that although a provider may perform two procedures that cannot be reported together based on a CCI edit, there is hope. If the procedure performed qualifies as 'substantially greater than typically required,' the physician may be able to report the column 1 [...]