Take-home message: Glaucoma specialists and general ophthalmologists alike must be aware of some significant procedure coding changes that will increase the complexity of the glaucoma surgical code set.
Current Procedural Terminology (CPT) for 2015, just as in 2014, includes significant modifications for glaucoma surgery reporting. At least some of the changes increase the complexity of the glaucoma surgical code “family.”
The Centers for Medicare and Medicaid Services (CMS) will likely enjoy substantial savings as a result of these changes. The associated impact in overall physician allowables has had notable impact on glaucoma specialists and general ophthalmologists alike.
The increase in complexity is related to expansion of the “aqueous shunt to extraocular plate reservoir” code set. This set was previously comprised of two separate codes describing placement of the aqueous shunt (CPT 66180) and revision of a previously placed shunt (CPT 66185).
CPT code 67255 (scleral reinforcement (separate procedure), with graft) was also a very relevant code in the context of these services. Prior to the 2015 change, it was permissible to report 67255 with either of the two shunt codes when a patch graft was used with the shunt.
However, as part of efforts to limit health-care spending, codes that are frequently reported together are identified for potential modification. Medicare’s idea is to combine frequently combined services into one inclusive code.
This process led to these changes that were implemented in 2015, which disallowed the separate reporting of graft code 67255.
These codes with the associated descriptors are part of CPT 2015:
- 66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
- 66180 Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
- 66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
- 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft.
(CPT 66179 and CPT 66184 are new codes, and CPT 66180 and CPT 66185 are revised codes.)
Reimbursement for the combined service captured in the new code descriptors for 66180 and 66185 is less than reimbursement for the code combinations that included the graft code that were used prior to 2015. This bundling policy has similarly resulted in reduction in physician payment for many services across the medical landscape.
These changes also affect facility payments.