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Facility coding for 66180 and new CMS guidance for corneal allograft tissue

Angela Posted Fri 24th of April, 2015 13:51:02 PM

There is a difference in the explanation of CPT 66180 from 2014 to 2015. This year the code includes the graft. considering this and the fact that CMS is now allowing ASC's to bill for the allograft tissue with code V2785, would it be fair to say that we should now be billing 66180 and V2785 - in place of 67255. Notes indicate we should not be billing 67255 with 66180. When would we use 67255?

SuperCoder Answered Mon 27th of April, 2015 03:00:08 AM

In order for facilities, hospitals outpatient departments and ambulatory surgical centers (ASCs) to receive reimbursement for donor tissue acquisition, they must remember to separately bill this service, and to also correctly code for the surgical procedure where the corneal tissue or donor tissue in glaucoma shunt graft procedures is used and thus considered an integral part of the procedure.

Since the ophthalmologist doesn't have to perform 67255 on every patient who gets a shunt, be sure the documentation includes information about the scleral thinning or other reason for the reinforcement procedure to support medical necessity for the additional procedure.

You may need to append modifier 51, Multiple procedures, to 67255, depending on your payer, because your provider performs more than one procedure during the same operative session. Medicare doesn't require you to use modifier 51 on a Medicare claim because the carrier will automatically add it, but you'll likely need the modifier for private payers.

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