DEC 18, 2019
Patient Requiring Ahmed and Baerveldt Implants in Same Session
Question: We have a patient who requires both Ahmed and Baerveldt implants due to the patient’s severity of vision loss and to aid in better IOP control. Since implants are both CPT code 66180 Aqueous shunt to extraocular equatorial plate reservoir; external approach; with graft, how should we submit?
Answer: For payers other than Medicare Part B, it’s best to prior authorize to determine coverage. The Academy’s health policy physicians recommended submitting 66180 -22 instead of 66180 and 66180 -59. That said, you should also think of the facility side. Both shunts and both patch grafts must be paid for out of the potentially one facility fee if modifier -22 is used. To help enable payment, provide indications including previous surgical history and disease status and a detailed operative report indicating the location of each incision. If the patient is monocular, be sure this is stated as well.