january 2016

Eye Surgeries that are Commonly Upcoded

A patient presents with glaucoma and the physician performs a procedure in which a goniotomy is first performed (an incision into Schlemm’s canal) and once an access point has been created a microcatheter is inserted and advanced 360 degrees through the canal to open it up and improve the flow of aqueous. This procedure is sometimes referred to as a GATT (Gonioscopy Assisted Transluminal Trabeculotomy).

Correct coding: 66174/66175 would be reported for transluminal dilation of aqueous outflow canal based on whether or not a device or stent is left in place.

Incorrect coding: 65820 for a goniotomy and 66170/66172 for a trabeculectomy.

CPT code 65426 represents excision of pterygium “with graft” – it does not matter what type of graft is used - Even if it was an amniotic membrane graft the coder would still report 65426 and not an ocular surface reconstruction with amniotic membrane code.

Additionally, whenever ocular surface reconstruction is performed and GLUE is the only method of fixation then unlisted CPT code 66999 is reported. An EX-PRESS glaucoma filtration device is a type of aqueous shunt that does not have an extraocular reservoir and is usually reported with CPT code 66183 when placed in the anterior chamber. It is not appropriate to additionally report a trabeculectomy code with these types of devices.

An iStent is known as “trabecular micro-bypass stent” and is usually inserted in conjunction with cataract surgery when a patient has documented diagnoses of both cataract and glaucoma. The iStent is another type of aqueous drainage device without an extraocular reservoir but this device is placed in the trabecular meshwork so it would be reported Category III code 0191T. It would not be appropriate to report 0191T or 66982 when the physician inserts an iStent to control intraocular pressure that may develop due to cataract surgery.

 

 

 







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