Ophthalmology and Optometry Coding Alert

Question: How should we code a trabeculectomy ab externo (66172) with a graft (67255)? Is there another code to use? The graft code is bundled.

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Answer: Code 67255 (scleral reinforcement [separate procedure]; with graft) is bundled with 66172 (fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma [includes injection of antifibrotic agents]) because the graft is a component or part of the total surgical procedure. The trabeculectomy (66172) is the main surgical procedure in this case. If the scleral graft and repair are performed at a separate time, or if they are unrelated to the trabeculectomy and performed in a different location from the trabeculectomy, code 67255 with modifier -59 (distinct procedural service) to indicate that the graft is unrelated to the trabeculectomy.

Check with your physician to see if a 66225 (repair of scleral staphyloma; with graft) was performed during the trabeculectomy, rather than 67255. Note that while 66225 is not bundled, a staphyloma is needed by scleral reinforcement to use this code.