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CODING & BILLING
scarring is present, 66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery
or trauma (includes injection of antifibrotic agents) is the correct
code (Source: July 2003 CPT Assistant, "Trabeculectomy: Filtering
Surgery for Glaucoma," page 1).
Both trabeculectomy codes belong to APC 0234 and have a
Medicare national payment rate of $1,676.62 under OPPS. For the ASC
payment system, the procedures both have a Medicare national payment rate of $940.80.
Beginning January 1, a new HCPCS code was created for ophthalmic mitomycin. HCPCS code J7315 Mitomycin, ophthalmic,
0.2mg can be reported for Mitosol, which, so far, is the only ophthalmic preparation of the drug that is FDA approved. Before the
implementation of this code, some facilities reported J9280 Injection,
mitomycin, 5mg for the ophthalmic use of mitomycin, however, this
is not appropriate. J7315 has an N status indicator and N1 payment
indicator per OPPS and the Medicare ASC payment system, respectively, and therefore no additional payment is made. Mitomycin is
often used during trabeculectomy surgery to prevent scarring. As per
the code descriptor for code 66172, injection of antifibrotic agents is
not separately coded with this procedure.
Complications of the bleb such as bleb leak and bleb dysesthesia
(discomfort) can occur after trabeculectomy surgery. When a revision
of the bleb is performed after initial trabeculectomy surgery, code
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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
