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0191T & 0376T WITH A CANALOPLASTY & CATARACT

Shamae Posted Mon 25th of November, 2019 17:14:04 PM
What would be the correct way to bill this procedure? The surgeon is claiming to have done a canaloplasty with an Omni, then cataract with a Istent inject to follow in our ASC
SuperCoder Answered Tue 26th of November, 2019 09:04:19 AM

Hi,

Thanks for your question.

Canaloplasty is a surgical procedure in which tissue flaps are cut in the conjunctiva and the sclera to expose the drainage area (Schlemm’s canal).

For reimbursement and billing purpose for canaloplasty with an omni and cataract with Istent injection the complete documentation and payer policy need to be reviewed, and the links below can provide you with the details of canaloplasty code and cataract surgery code with 0191T and 0376T.

https://www.glaukos.com/healthcare-professionals/reimbursement/

https://omnisurgical.com/wp-content/uploads/2019/09/OMNI-Reimbursement-Coding-Guide.pdf

Please feel free to ask if you have any questions.

Thanks.

Shamae Posted Tue 26th of November, 2019 11:45:40 AM
Sorry, but this isn't telling me what I need to know. Can I bill this as three separate procedures or is the Istent part of the canaloplasty? 66174 or 66175, with 66984? Or 0191T/0376T, with 66174 and 66984?
SuperCoder Answered Wed 27th of November, 2019 09:51:30 AM

Hi,

Can you please provide us documentation of operative report excerpt so that we can provide you with the appropriate answer.

Thanks.

 

Shamae Posted Wed 27th of November, 2019 15:39:11 PM
I have the Op report, how would you like me to provide it to you? I do not have a choice here to copy/paste or download.
SuperCoder Answered Thu 28th of November, 2019 09:04:30 AM

Okay.

 

Yes, you won't be able to place the operative report in this forum. We thought you might have a excerpt of the procedure. 

 

If the surgeon performed transluminal dilation through aqueous outflow canal to treat glaucoma, without retention of device or stent then code 66174 will be appropriate and if with retention of device then code 66175 should be used. Code 66984 is also coded for extracapsular cataract removal with IOL prosthesis.

 

Codes 0191T is insertion of anterior segment device used to drain aqueous fluid from eye to lower intraocular pressure in patient with glaucoma and may not be billed. The Istent should not be billed separately.

 

Hope this helps.

Thanks.

Shamae Posted Mon 02nd of December, 2019 12:21:07 PM
No, I'm sorry this does not help. I understand the codes. This issue is, that the surgeon feels this is 3 separate procedures and should be billed as such. 0191T, 66174 and 66984. He is saying that he did not use the Istent to preform the Canaloplasty , that the Istent is its own. But I would like to clarify that this is so. So, with that being said. is he correct and I can bill as 3 or since he did use an Istent would that have to be included in the Canaloplasty and it would have to be billed as an 66175?
SuperCoder Answered Tue 03rd of December, 2019 08:57:26 AM

Hi,

Since the involved scenario is tricky and require further research. Kindly share operative report on customerservice@supercoder.com.

Once we get the report, we will provide you with our findings.

Thanks.

 

Shamae Posted Mon 09th of December, 2019 14:50:24 PM
I sent that to you on 12/3/19 has anyone had time to review and help with this billing issue?
SuperCoder Answered Wed 11th of December, 2019 06:45:16 AM

Hi,

First of all, apologies for delayed response.

Our sales team tried to get in touch with you, call was directed to your voice mail which stated you are on vacation and not available for 10 days. Hence, the delay.

Per the submitted operative note, CPT code 66984 would be the appropriate CPT code that should be billed for cataract extraction. Also, CPT code 66174 would also be appropriate CPT code as transluminal dilation up to extent of 1.75mm of aqueous outflow canal was performed.

Submitted documentation does not state that Insertion of anterior segment aqueous drainage device was performed on the day of surgery. Hence CPT code 0191T/0376T cannot be billed.

Thanks.

Shamae Posted Thu 12th of December, 2019 12:24:08 PM
I'm not sure who they called but I do not have a voice mail and have not been on vacation, but thank you for this!
SuperCoder Answered Fri 13th of December, 2019 00:04:44 AM

Thank you, happy to help.

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