Glaucoma specialists and ophthalmologists are required to pay more attention to their medical coding tasks now since Current Procedural Terminology (CPT) for 2015 has introduced significant changes in glaucoma surgery reporting. The Centers for Medicare and Medicaid Services (CMS) is likely to gain substantial savings through the new changes, but there would be an overall reduction in Medicare reimbursement. Moreover, the expansion to the code set for shunt procedures may add complexities to glaucoma surgery coding. Let’s take look at the crucial changes to glaucoma surgery reporting in 2015.
Category I Codes
The new ‘aqueous shunt to extraocular plate reservoir’ code set was earlier composed of two separate codes that specify the placement of the aqueous shunt (66180) and revision of a previously placed shunt (66185). The CPT code 67255 (scleral reinforcement (separate procedure), with graft) was also a very important code related to these services. It was allowed to report 67255 with any of the two shunt codes if a patch graft was used with the shunt. The new changes combined frequent combined services into one inclusive code and disallowed separate reporting of 67255. The new codes (66180 and 66185 are revised) are as follows:
- 66179: Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
- 66180: Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
- 66184: Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
- 66185: Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft
The reimbursement for the combined service described by the new code descriptors for 66180 and 66185 is less than the reimbursement for the code combinations used prior to 2015, and which included the graft code. The new changes also have an impact on facility payments.
The following is the CPT code deleted for 2015.
- 66165: Fistulization of sclera for glaucoma; iridencleisis or iridostasis
Category III Codes
There occurred crucial changes in Category III codes of CPT for glaucoma procedure coding. The Category III codes are Emerging Technology Codes and they are typically updated every 6 months. The revised codes are:
- 0191T: Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion
- 0253T: Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space
New code (add-on)
- 0376T: each additional device insertion (List separately in addition to code for primary procedure)
You should use 0376T in conjunction with 0191T.
Medicare Coding – Key Points to Remember
When it comes to coding for glaucoma surgery for Medicare, you should take note of the following things.
- In the case of both Ambulatory Surgery Center (ASC) and physician coding, you should code 0191T first before the cataract surgery code, as 0191T is the highest paying code.
- You should not use 66179 and 67255 along with the modifier 59 to break the NCCI bundles since Medicare would take it as improper coding for any procedures performed on or after January 1, 2015.
- The add-on code 0376T should be used for multiple stents inserted during the same session.
You should thoroughly understand the guidelines and regulations specified by your Medicare Administrative Contractor’s Local Coverage Determination (LCD) when using the new CPT codes.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.