january 2018

Ophthalmology

As we begin 2018, there are a couple of new ophthalmology codes that you should be aware of.  Two things you should consider are will my carriers reimburse the ASC for these services and anatomical location at which the procedure is being performed so that the case is coded correctly.

So let’s start with the CyPass anterior segment aqueous drainage device.  This stent is placed into one of two anatomical sites.  It can be inserted into either the suprachoroidal space (0253T) or the supracilliary space (0474T).  Confirm the anatomical location at which the CyPass is being inserted and don’t assume that just because it’s a CyPass it is automatically reported as 0474T.

As for reimbursement, both of these codes are on the Medicare List of ASC Approved Procedures for 2018.  There are however, a number of other carrier policies that can be found online which indicate that the CyPass and other aqueous drainage devices (except iStent) are considered “unproven and not medically necessary” so it is recommended that you confirm your individual carriers policy.

The other new Category III code is 0465T Suprachoroidal injection of pharmacologic agent which is similar to 67028, except that 67028 is Intravitreal injection of pharmacologic agent.  Once again the coder needs to be wary of the anatomical site at which the injection is being performed so that the correct code is reported.

 







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