EyeNet Magazine

Savvy Coder: Coding & Reimbursement

New ASC List Announced: Know What’s Covered
By Sue Vicchrilli, COT, OCS, Academy Coding Executive

Every two years, the Centers for Medicare & Medicaid Services is required to update its list of ASC services. Its new list—which goes into effect on July 5—has been expanded to include 10 additional ophthalmic codes. Also in response to Academy urging, the CMS decided to keep 15 codes on the ASC list that it had originally slated for deletion.

Additional Codes Covered
The following codes will now be covered for services that are furnished on or after July 5:
65780 Ocular surface reconstruction; amniotic membrane transplantation
65781 Ocular surface reconstruction; limbal stem cell allograft (e.g., cadaveric or living donor)
65782 Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)
65820 Goniotomy
66711 Ciliary body destruction; cyclophotocoagulation, endoscopic
67343 Release of extensive scar tissue without detaching extraocular muscle (separate procedure)
67445 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of bone for decompression
67570 Optic nerve decompression (e.g., incision or fenestration of optic nerve sheath)
67912 Correction of lagophthalmos, with implantation of upper eyelid lid load (e.g., gold weight)
68371 Harvesting conjunctival allograft, living donor

Codes Not Covered
It is sometimes assumed that an ASC can bill the 36 CPT codes listed below, but that is not the case.

Despite Academy lobbying, the following codes are still not payable when performed in an ASC.

Integumentary (Skin) section of CPT. An ASC cannot bill for the following codes: 11440, 11441, 11442, 11443, 11640, 11641, 11642, 11643, 12011, 12013, 12014, 12015, 12051, 12052, 12053, 13153, 21386, 21390, 21406
and 21407

Eye and Ocular Adnexa section of CPT. An ASC cannot bill for the following codes:
65125 Modification of ocular implant with placement or replacement of pegs (e.g., drilling receptacle for prosthesis appendage) (separate procedure)
65130 Insertion of ocular implant secondary; after evisceration, in scleral shell
65135 Insertion of ocular implant secondary; after enucleation, muscles not attached to implant
65771 Radial keratotomy
+66990 Use of ophthalmic endoscope (list separately in addition to code for primary procedure)
67028 Intravitreal injection of a pharmacologic agent (separate procedure)
67101 Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage
of subretinal fluid
67228 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; photocoagulation (laser or xenon arc)
67810 Biopsy of eyelid
67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure
67850 Destruction of lesion of lid margin (up to 1 centimeter)
68100 Biopsy of conjunctiva
68110 Excision of lesion, conjunctiva; up to 1 cm
68400 Incision, drainage of lacrimal gland
68420 Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)
68530 Removal of foreign body or dacryolith, lacrimal passages

Next Month: Reimbursement rules for the ambulatory surgery center.

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