Shunt Insertion With Graft

By Author: erinarticle
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Here's an ophthalmology coding scenario that you might encounter while going about your routine work.


Scenario: Our physicians are not sure how to go about this situation - would it be proper to bill for both 66180 and 67255 at the same OR session and same eye for an aqueous shunt insertion and a scleral reinforcing graft?


Well, you should be able to report both the aqueous shunt procedure (66180, Aqueous shunt to extraocular reservoir [example, Molteno, Schocket, Denver-Krupin]) and the reinforcement (67255, Scleral reinforcement [separate procedure]; with graft).


As the ophthalmologist does not have to perform 67255 on every patient who gets a shunt, be sure the documentation includes information about the sclera thinning or other reason for the reinforcement procedure to support medical necessity for the additional procedure.


Note down: You may need to append modifier 51 (multiple procedures) to 67255, depending on your carrier as your physician performed more than one procedure during the same operative session. Medicare does not require you to ...
... use modifier 51 on a Medicare claim because the carrier will automatically add it; however you will likely need the modifier for private payers. Link the proper glaucoma diagnosis to 66180 for the shunt insertion, and link 379.04 (Scleromalacia perforans) to 67255 for the graft.


Remember: These procedures are unilateral and should be reported with modifier LT (Left side), RT (Right side), or 50 (Bilateral procedure) as pointed out.


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