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CODING & BILLING
status indicator and are therefore packaged into the main procedure for
Medicare, this rate includes reimbursement for the device(s) as well as
for the procedure. Code 67255 belongs to APC 0237, which has a
Medicare national payment rate of $1,442.12. This rate would include
the reinforcement graft(s), which are packaged due to their N status
indicator.
For ambulatory surgery centers, the aforementioned glaucoma
codes have a Medicare national payment rate of $1,671.00 for 2013. As
is the case with OPPS, the device codes for these procedures are
packaged into the code for the main procedure by virtue of their N1
payment indicator under the ASC payment system. Therefore, the
payment rate for the procedure includes payment for the device(s).
Code 67255 has a Medicare national payment rate of $809.22 for ASCs.
Trabeculectomy
Trabeculectomy is the most common surgical procedure performed for
the treatment of glaucoma. For this procedure, typically a scleral flap
is created through which a small block of trabecular tissue is excised,
creating a fistula through which aqueous can flow out of the anterior
chamber. A conjunctival flap is sutured over the scleral flap to form a
bleb that acts as a reservoir for the outflowing aqueous.
When this is done in the absence of scarring due to surgery and/or
trauma, you should report 66170 Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery. When
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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
