• 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

    This article is from May 2005 and may contain outdated material.

    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