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Young Ophthalmologists
Ophthalmology Coding, Pt. 2: Keratoplasty to YAG Capsulotomy
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Last month, we began highlighting key points in coding the services most frequently performed in ophthalmology, from A-scan ultrasound for intraocular lens calculations through foreign body. This month, we’ll pick up with keratoplasty.

Keratoplasty
There are five options for transplanted cornea.

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  1. 65710 Keratoplasty (corneal transplant); anterior lamellar;
  2. 65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia);
  3. 65750 Keratoplasty (corneal transplant); penetrating (in aphakia);
  4. 65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia);
  5. 65756 Keratoplasty (corneal transplant); endothelial.
All of these procedures carry a 90-day global period.

Lacrimal Punctal Plugs
CPT code 68761 Closure of the lacrimal punctum; by plug, each.

This is the only lacrimal procedure where payment is per puncta, not per eye. The code is the same whether using temporary (collagen) or permanent (silicone) plugs. Typically, it is not necessary to distinguish the difference to the payer. In 2002, Medicare bundled the supply of the plug(s) with the insertion. Non-Medicare payers may pay separately for the supply of the plug with HCPCS Level II codes A4262 Temporary, absorbable lacrimal duct implant, each for collagen; A4263 Permanent, long term, non-dissolvable lacrimal duct implant, each for silicone; or CPT code 99070 Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided).

Patient complaint should document: dryness, burning, itching, excessive tears and/or photophobia. Documentation should indicate other methods of treatment have been tried and proven unsuccessful before plug insertion. This could include artificial tears, ointments, humidifier, etc.

CPT code 68761 has a 10-day global period.

Optic Nerve Scan
CPT code 92135 Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and report, unilateral.

In 2007, this service was billed more than six million times to Medicare. One hundred percent of the allowable is paid per eye, when medical necessity exists. Significant payment/coverage changes to this code will occur in 2011.

Ophthalmoscopy
CPT codes 92225 Ophthalmoscopy, extended with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial and 92226 Ophthalmoscopy, extended with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent.

As with other procedures that have unilateral payment, 100 percent of the allowable is paid per eye, when medical necessity exists. Payment is for the detailed drawing, not for viewing. The drawing should be detailed, but payers no longer require a colored drawing.

Pachymetry
CPT code 76514 Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness).

Payment for 76514 is the same whether testing one or both eyes. This procedure is covered by Medicare as a one-time basis for glaucoma usually, but also as indicated in the progression of corneal disease.

Pterygium
CPT codes 65420 Excision or transposition of pterygium; without graft and 65426 Excision or transposition of pterygium; with graft.

No matter the source of the graft, it is bundled with the surgical code (65426). Amniotic membrane transplant is not separately billable per Correct Coding Initiative (CCI).

CPT codes 65420 and 65426 have a 90-day global period.

Suture Removal
CPT codes 15850 Removal of sutures under anesthesia (other than local), same surgeon; and 15851 Removal of sutures under anesthesia (other than local), other surgeon.

Aside from these two codes, suture removal is never separately payable. It is part of the global surgical fee, or any E&M or eye code billed if you were not the surgeon or if the patient is out of the global period. Never report suture removal as a corneal foreign body. Laser suture lysis is considered suture removal. It is inappropriate to code 66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure for this service.

Topography
CPT code 92025 Computerized corneal topography, unilateral or bilateral, with interpretation and report.

This was a new code in 2007. Payment is the same whether one or both eyes are tested. Do not report 92025 with any corneal transplant code after the decision for surgery has been made, and until the end of the global period. This helps to maintain the value of the surgical code.

Visual Fields
CPT code 92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent), 92082 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33), and 92083 Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least three isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).

Payment for these codes is the same whether one or both eyes are tested. CPT code 92081 or 92082 is appropriate for documentation prior to blepharoplasty.

YAG Laser Capsulotomy
CPT code 66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (one or more stages).

Typical LCD indicates documentation should reflect:
  • Vision loss due to decreased light transmission (visual acuity of 20/30 or worse after other acuity loss causes have been ruled out).
  • Increased glare. Test results must show decrease in two lines of visual acuity in glare tester.
  • Indication of the impact the reduced vision has on the patient’s daily activities.
Medicare does not expect to see this procedure performed regularly within the cataract global period, and may request documentation. YAG lasers carry a 90-day global period.

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About the author: This article was adapted from a version that originally appeared in the February 2009 issue of Coding Bulletin. It was written by AAOE coding executive Sue Vicchrilli, COT, OCS, and Academy coding specialist Kim Ross, CPC, OCS.

 
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