Coding & Reimbursement

Meibomian gland disease and reimbursement

By Suzanne Corcoran

Treatment of meibomian gland dysfunction (MGD) is garnering increased interest, but you need to consider reimbursement issues.

Q What treatments are available for MGD?

A Treatment is based on keeping the meibomian gland secretions flowing normally. Sometimes antibiotics, artificial tears, or warm compresses are used for symptomatic and temporary relief of this chronic and often recurrent condition. Other treatments involve the use of controlled heat and automated or manual compression to soften and move the meibum secretions out of the tiny openings on the lid margin.

Q What documentation is required to support treatment?

A As with any planned treatment, medical necessity must exist.

In MGD, medical necessity is most commonly based on the provider’s examination of the lids and their function. Findings would need to be matched with a pertinent patient complaint; asymptomatic patients would not likely be treated.

Q How is this treatment reimbursed?

A Medicare and commercial payers do not cover most treatments for MGD; they consider them too new and investigational or experimental. When this is the case, collect the fee from the patient after discussing financial responsibility. Use an Advance Beneficiary Notice of Noncoverage (ABN) for Medicare and a similar financial waiver for other insurers.

Q What CPT code applies: 67700 or 0207T?

A These treatments are not properly coded as blepharotomy (67700) because probing of the meibomian gland orifices allows the meibum to have an “escape route.” With no incision made to support the suffix “-otomy”, 67700 is incorrect.

Intraductal probing (eg, the Maskin Probe) is used to manually “move” the clogged meibum out of the glands. There is no code for its use; if done alone, this would also be coded as 67999, and be reported per eye if both eyes are treated.

Category III code 0207T (evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral) is only appropriate when using an automated instrument (eg, LipiFlow from TearScience). Manual probing or expression of the glands does not qualify. Remember that CPT directs that a “close enough” code choice is not acceptable. When no specific code exists, the only option is a miscellaneous code.

Q What is meibomian gland dysfunction?

A The meibomian glands are an important part of proper tear and eyelid function.

They are located along the eyelid margin just behind the eyelashes. These glands have openings that secrete meibum onto the surface of the eye and tears. Meibum is an oily substance containing lipids and is critical in the prevention of tear film evaporation.

Dysfunction of the meibomian glands most often results in certain types of blepharitis or blockage of the glands. Common patient complaints include grittiness upon blink, chronic foreign-body sensation and dry eyes.