Ophthalmology and Optometry Coding Alert

Question: Can 66984 and 65805* be billed together? Does 65805* require a separate identifiable diagnosis besides cataract (366.57)?

John Bierly
Southeast Eye Specialists, Chattanooga, Tenn.

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.




Answer: Code 65805 (paracentesis of anterior chamber of eye [separate procedure]; with therapeutic release of aqueous) is defined as a separate procedure. By definition, this means that the procedure, while it can be performed separately, is generally included in a more comprehensive procedure. As a result, the service may not be reported when a related, more comprehensive, procedure is performed. A review of Medicares Correct Coding Initiative (CCI) does not, however, show 65805 as being bundled into 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Despite the fact that the services do not appear to be bundled in the CCI, you would have to provide sufficient documentation to show that the procedure (65805) was of sufficient medical necessity and work to justify the use of this code. Therefore, you should have a diagnosis that is different from cataract to support the medical necessity of performing 65805. You still run the risk of having the procedure denied because 65805 is considered a separate procedure. Check your Medicare carrier bulletins for any items on separate procedures, and contact the carrier for its policy on the use of these two codes.