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May 2005

Savvy Coder: Coding & Reimbursement

45 Procedures That Are Now Paid Per Eye, Not Per Session
By Sue Vicchrilli, COT, OCS, Academy Coding Executive, and
Michael X. Repka, MD, OCS, Secretary for Federal Affairs

Thanks to the combined efforts of the Academy and the AAOE, there is a new coverage policy for 45 CPT codes. This policy went into effect on April 4 and is retroactive to Jan. 1. When performed bilaterally, the following codes are now paid at 150 percent of the allowable, rather than 100 percent as used to be the case: 

67950 Canthoplasty (reconstruction of canthus)
67961 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin
67966  over one-fourth of lid margin
67971 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid, up to two-thirds of eyelid, one stage or first stage
67973  total eyelid, lower, one stage or first stage
67974  total eyelid, upper, one stage or first stage
67975  second stage
67999 Unlisted procedure, eyelids
68020 Incision of conjunctiva, drainage of cyst
68100 Biopsy of conjunctiva
68110 Excision of lesion, conjunctiva; up to 1 centimeter
68115 over 1 cm
68130 with adjacent sclera
68135 Destruction of lesion, conjunctiva
68320 Conjunctivoplasty; with conjunctival graft or extensive rearrangement
68325 with buccal mucous membrane graft (includes obtaining graft)
68326 Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement
68328 with buccal mucous membrane graft (includes obtaining graft)
68330 Repair of symblepharon; conjunctivoplasty, without graft
68335 with free graft conjunctival or  buccal mucous membrane graft (includes obtaining graft)
68340 division of symblepharon, with or without insertion of conformer or contact lens
68360 Conjunctival flap; bridge or partial (separate procedure)
68362  total (such as Gunderson thin flap or purse-string flap)
68371 Harvesting conjunctival allograft, living donor
68399 Unlisted procedure, conjunctiva
68400 Incision, drainage of lacrimal gland
68420 Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)
68440 Snip incision of lacrimal punctum
68500 Excision of lacrimal gland (dacryoadenectomy), except for tumor; total
68505 partial
68510 Biopsy of lacrimal gland
68520 Excision of lacrimal sac (dacryocystectomy)
68525 Biopsy of lacrimal sac
68530 Removal of foreign body or dacryolith, lacrimal passages
68540 Excision of lacrimal gland tumor frontal approach
68550 involving osteotomy
68700 Plastic repair of canaliculi 
68705 Correction of everted punctum, cautery
68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
68745 Conjunctivorhinsotomy (fistulization of conjunctiva to nasal cavity); without tube
68750 with insertion of tube or stent
68770 Closure of lacrimal fistula (separate procedure)
68840 Probing of lacrimal canaliculi, with or without irrigation
68850 Injection of contrast medium for dacryocystography
68899 Unlisted procedure, lacrimal system.