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November 2007

 
Savvy Coder: Coding & Reimbursement
ASC Coverage for 2008: Here’s What to Expect
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
 

If all goes as planned, Jan. 1 will be a red-letter day for ambulatory surgery centers. The list of procedures that they can bill to CMS is likely to get considerably longer, with approximately 790 CPT codes being added to it. More than 60 of those CPT codes will be for ophthalmic procedures. (The new rule will essentially permit all procedures to be performed in an ASC unless prohibited by CMS as posing a significant safety risk or requiring an overnight stay.)

When will we know for sure what those 60-plus ophthalmic procedures will be? The government has indicated that it will list them in a November edition of the Federal Register, the daily publication where federal agencies announce any new rules, proposed rules or other notices (www.gpoaccess.gov/fr).

Here is a quick summary of the codes that we expect to appear.

Minor Surgeries

The global period for these is either zero or 10 days.

Eyeball:

  • Removal of foreign body. 65205 Removal of foreign body, conjunctiva; 65210 Removal of foreign body, embedded; 65220 Removal of foreign body, corneal, without slit lamp; 65222 Removal of foreign body, corneal, with slit lamp.

Anterior Segment:

  • Removal or destruction. 65435 Removal of corneal epithelium; 65855 ALT/SLT.

Posterior Segment:

  • Vitreous. 67028 Intravitreal injection.
  • Retina or choroid. 67221 PDT; 67225 PDT second eye same day.

Ocular Adnexa:

  • Strabismus surgery. 67345 Chemodenervation of extraocular muscle.
  • Orbit. 67500 Retrobulbar injection; 67505 Retrobulbar injection, alcohol; 67515 Injection of medication into Tenon’s capsule.
  • Eyelids—incision. 67700 Blepharotomy, eyelid; 67710 Severing of tarsorrhaphy.
  • Eyelids—excision, destruction. 67800 Excision of chalazion, single; 67801 Excision of chalazion, multiple, same lid; 67805 Excision of chalazion, multiple, different lids; 67820 Correction of trichiasis, epilation; 67825 Correction of trichiasis, other than forceps; 67840 Excision of lesion of eyelid; 67850 Destruction of lesion of lid margin.
  • Eyelids—tarsorrhaphy. 67875 Closure of eyelid by suture.
  • Eyelids—reconstruction. 67930 Suture of eyelid wound; 67938 Removal of embedded eyelid foreign body.

Conjunctiva:

  • Incision and drainage. 68020 Incision of conjunctiva, drainage of cyst; 68040 Expression of conjunctival follicles.
  • Excision and/or destruction. 68100 Biopsy of conjunctiva; 68110 Excision of conjunctival lesion; 68135 Destruction of conjunctival lesion.
  • Injection. 68200 Subconjunctival injection.

Lacrimal System:

  • Incision. 68400 Incision, drainage of lacrimal gland; 68420 Incision, drainage of lacrimal sac; 68440 Snip incision of lacrimal punctum.
  • Excision. 68530 Removal of foreign body, lacrimal passages.
  • Repair. 68705 Correction of everted punctum, cautery; 68760 Closure of lacrimal punctum, by thermocauterization; 68761 Closure of lacrimal punctum, by plug.
  • Probing and/or related procedures. 68801 Dilation of lacrimal punctum; 68840 Probing of lacrimal canaliculi; 68850 Injection of contrast medium.

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CHALAZION REMOVAL. Since procedures like this don’t pose a significant safety risk or require an overnight stay, they are expected to be on the list of procedures reimbursable in an ASC.

Historically, when the service has not been covered in an ASC, no facility payment is made by any payer. The physician received payment at the nonfacility higher rate. And the physician—not the patient—was responsible for the ASC fee. An Advance Beneficiary Notice should never have been used.



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Major Surgeries

The global period for these is 90 days.

Eyeball:

  • Secondary implant(s) procedures 65125 Revise ocular implant
  • Lacerations. 65286 Repair of laceration with glue.

Anterior Segment:

  • Cornea—removal or destruction. 65436 Removal of corneal epithelium with application of chelating agent; 65450 Destruction of lesion by cryotherapy; 65600 Punctures of anterior cornea.
  • Anterior chamber. 65860 Severing adhesions of anterior segment.
  • Iris, ciliary body—destruction. 66761 Iridotomy/iridectomy by laser; 66762 Iridoplasty; 66770 Destruction of cyst or lesion.
  • Lens—incision. 66820 Discission, secondary cataract.

Posterior Segment:

  • Retina or choroid—repair. 67101 Repair of retinal detachment, cryotherapy; 67105 Repair of retinal detachment, photocoagulation; 67110 Repair of retinal detachment, pneumatic retinopexy.
  • Retina or choroid—prophylaxis. 67145 Prophylaxis of retinal detachment, photocoagulation.
  • Retina or choroid—destruction. 67208 Destruction of localized lesion of retina, cryotherapy; 67210 Destruction of localized lesion of retina, photocoagulation; 67220 Destruction of localized lesion of choroid; 67228 Destruction of retinopathy; photocoagulation.

Ocular Adnexa:

  • Orbit—exploration, excision, decompression. 67414 Orbitotomy with removal of bone for decompression.
  • Eyelids—repair (brow ptosis, blepharoptosis, lid retraction, ectropion, entropion). 67915 Repair of ectropion, thermocauterization; 67922 Repair of entropion, thermocauterization.

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Coding in New Orleans

New Orleans legend Louis “Satchmo” Armstrong was once asked to explain jazz. His response—“If you have to ask what it is, you’ll never know”—suggests that, in another life, he might have been head of communications at a carrier’s claims department. Fortunately, you can take the mystery out of coding by attending some of this year’s events:

ON SATURDAY. AAOE Coding Camp: A Workshop to Appropriately Maximize Reimbursement—8 a.m. to 3:30 p.m., with breakfast from 7 to 8 a.m. Learn how to code for exams, consultations, special testing services and both major and minor surgical procedures. Instruction will be at the intermediate level and will be provided by Sue J. Vicchrilli, COT, OCS, Byrd Evans, OCS, Stephen A. Kamenetzky, MD, OCS, and Michael X. Repka, MD. Coding Camp is offered in collaboration with the Joint Commission on Allied Health Personnel in Ophthalmology. (Unlike the courses listed below, you can register for Coding Camp without being registered for the Annual Meeting. Go to the Onsite Registration desks in Hall E; registration is $365.)

ON SUNDAY. Ambulatory Surgery Center Billing and Reimbursement—2 to 3 p.m. (The instructor for course 213 is Sara Burns Rapuano, MBA, OCS, and tickets cost $35.)

The Physician’s Quality Reporting Initiative: Real-Life Application—2 to 4:15 p.m. (Course 229; Sue J. Vicchrilli, COT, OCS; $70.)

The ABCs of RVUs—3:15 to 4:15 p.m. (Course 244; Derek A. Preece, MBA; $35.)

Common Coding Errors: A Panel Discussion—4:30 to 5:30 p.m. (No ticket is needed for this interactive workshop, which will take place in Room 393; seating will be limited.)

ON MONDAY. Introduction to Ophthalmic Coding—9 to 11:15 a.m. (Course 361; Byrd Evans, OCS; $70.)

Making the Most With Modifiers—10:15 a.m. to 12:30 p.m. (Course 390; L. Neal Freeman, MD, MBA; $70.)

Medical and Surgical Retina Coding: From Angiotherapy to Vitrectomy and Every Case in Between—2 to 4:15 p.m. (Course 435; George A. Williams, MD; $70.)

The Anatomy of Surgical Coding—4:30 to 5:30 p.m. (Course 478; Nancy Faires, OCS; $35.)

ON TUESDAY. When to Use E&M and When to Use Eye Codes—9 to 11:15 a.m. (Course 562; Sue J. Vicchrilli, COT, OCS; $70.)

Coding the Common and the Complex—11:30 a.m. to 12:30 p.m. (Course 611; Gordon E. Johns, MD; $35.)

IN YOUR STATE. CodeQuest—throughout the year, the AAOE combines with state societies to provide state-specific seminars. Pick up a list of upcoming seminars from the Coding Questions desk or visit www.aao.org/codequest.

NEED CODING ASSISTANCE? Visit the Coding Questions desk at the Academy Resource Center (Hall G, Booth # 2939) to chat with AAOE experts—such as Stephen A. Kamenetzky, MD, OCS, Sue J. Vicchrilli, COT, OCS, John Haley, MD, and Byrd Evans, OCS—and to explore resources, like 2008 Code This Case, 2008 Ophthalmic Coding Coach (both a book and a CD-ROM).

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