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Retina Surgery 67042

Molly Posted Wed 13th of June, 2012 15:26:23 PM

Is there a code to bill for focal endolaser photocoagulation performed during repair of macular hole (67042)?
The 67039 code for laser bundles with 67042.

SuperCoder Answered Wed 13th of June, 2012 15:53:25 PM

You cannot separately code for 67039 when 67042( a higher RVU procedure is being performed)together. It bundles as you mentioned..

Molly Posted Wed 13th of June, 2012 20:13:37 PM

It's kind of strange how 67043 allows RVU's for the laser but the membrane is 'subretinal' and not 'internal limiting'. Does this mean that you can only get credit for the laser if you remove the subretinal membrane and will not get credit for a laser if you remove the internal limiting membrane?

SuperCoder Answered Tue 14th of August, 2012 20:00:24 PM

This is how is it.CCI has paired several vitrectomy procedures into mutually exclusive bundles, which means that practitioners would not usually perform the two bundled codes together. If you do report the two codes separately without modifiers, Medicare payers will only reimburse for one of them.

Mark these edits: Code 67039 (Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation) is bundled into 67040 (... with endolaser panretinal photocoagulation), 67041 (... with removal of preretinal cellular membrane [e.g., macular pucker]), 67042 (...with removal of internal limiting membrane of retina [e.g., for repair of macular hole, diabetic macular edema], includes, if performed, intraocular tamponade [i.e., air, gas, or silicone oil]), and 67043 (...with removal of subretinal membrane [e.g., choroidal neovascularization], includes, if performed, intraocular tamponade [i.e., air, gas, or silicone oil] and laser photocoagulation).

A previous edit put 67039 into column 1 and 67040 into column 2 of a mutually exclusive bundle.In a mutually exclusive bundle (as with a column 1/column 2 bundle), Medicare payers will only recognize the column 1 procedure if you report the two together without modifiers.

So, if you were to report 67040 and 67039 together without a modifier, you would only see reimbursement for the column 1 procedure, 67040.

Also, 67040 is now bundled into 67042 and 67043. Code 67041 is bundled into 67040, 67042, and 67043; and 67042 is bundled into 67043.

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