ASC Coding for Ophthalmology: Minimally Invasive Glaucoma (MIG) Procedures
By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
WATCH THE ANATOMY OF CODING Opthalmology CODING COURSE ON DEMAND. Register here
ASC coding updates for Ophthalmology, particularly for Minimally Invasive Glaucoma (MIG) procedures, have been conflicting at best. This all started when the Centers for Medicare & Medicaid Services (CMS) embarked on a process to revise Local Coverage Determinations (LCDs) for MIG procedures. Initially slated for release, these updates were abruptly withdrawn following a public comment period.
As the future LCDs were removed from the CMS database, many ASC coders were left wondering, “So where does this leave us now?”
One topic of concern for MIG procedures was the OMNI Surgical System. These new policies indicated OMNI would be considered investigational. Since the policies were pulled, this is no longer the case.
As of today, there aren’t any OMNI coding changes for Medicare beneficiaries. However, other carriers maintain specific coding policies for OMNI, and these differ from Medicare. It’s important for ASC coders to know these distinctions to ensure accurate coding for reimbursement.
ASC Coding for OMNI, MIG Procedures
Medicare policy changes affect coding and billing for Medicare beneficiaries. However, other insurance carriers maintain their own distinct coding guidelines that may conflict with Medicare. This happens to be the case for OMNI and other MIG procedures:
- Aetna CPB Number 0435: OMNI is considered experimental/investigational
- UHC Policy Number 2023T0443GG: OMNI is unproven and not medically necessary
- Cigna Medical Coverage Policy 0035: Canaloplasty (CPT Code 66174, 66175), whether performed ab externo or ab interno, is considered medically necessary
Based on the above distinctions, submitting to Aetna or UnitedHealthcare for OMNI reimbursement will result in a claim denial.
These diverse payer policies illustrate why it’s important to verify a patient’s insurance coverage and their out-of-pocket estimates prior to performing a procedure. Depending on the payer, a patient may be responsible for the entire cost of a MIG procedure.
CPTs Cigna Requires: Canaloplasty vs Viscocanalostomy
Cigna’s Medical Coverage Policy 0035 details what a canaloplasty is versus a viscocanalostomy and which CPTs apply to each procedure:
- Canaloplasty entails a comprehensive 360-degree dilation of Schlemm’s canal, with specific CPT codes (66174 or 66175) designated for reporting.
- Viscocanalostomy involves partial dilation. Whenever the physician does not achieve a full 360 degree dilation, Cigna requires reporting unlisted procedure code (66999), anterior segment of eye.
By aligning your coding practices with each payer’s guidelines, ASCs can uphold compliance standards and safeguard their revenue streams.
ASC Coding Education: Ophthalmology
Attend the 2024 Ophthalmology coding course on February 20th at 1pm Central. This course will improve your ASC coding knowledge for Ophthalmology, including Minimally Invasive Glaucoma (MIG) procedures.
During this course, we’ll delve further into the intricacies of specific payer coding policies for glaucoma procedures. Plus, participants can receive CEUs from AAPC.
Find more information and registration details here.