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CODING & BILLING
Denis Rodriguez, CPC
Keeping Up With Glaucoma Coding
As glaucoma surgery evolves, getting paid your due can be tricky.
laucoma surgery is evolving at such a frenzied pace that CPT
G
and HCPCS codes sometimes struggle to keep up. You might,
too, as new codes are introduced and existing codes are
amended almost yearly. Let's step back and review how to correctly
report glaucoma for maximum reimbursement.
Shunting procedures
The oldest of the codes considered in this subheading, code 66180
Aqueous shunt to extraocular reservoir (e.g., Molteno, Schocket,
Denver-Krupin) , refers to the placement of a shunt into the anterior
chamber that drains aqueous humor to a plate that serves as a reservoir on the posterior segment of the ocular surface. In addition to
the devices given as examples in the code descriptor, Ahmed and
Baerveldt devices are also commonly implanted during this procedure.
You can report the code for scleral reinforcement (67255) in addition to the code for aqueous shunt implantation when you document
this procedure, according to the June 2012 CPT Assistant. The
National Correct Coding Initiative (NCCI) has no edit for these procedures and therefore a modifier to unbundle them is not necessary for
Medicare; however, the aforementioned CPT Assistant article suggests appending a —59 modifier to code 67255 due to its "separate
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A R C H 2013
