Cataract surgery is frequently performed in conjunction with glaucoma stent procedures. In 2022, we have new CPT codes to describe these combination procedures.

Q. What glaucoma stent procedures are performed with cataract surgery?

A. Implantation of a small aqueous drainage device, frequently referred to as a “stent” or “microstent,” is currently FDA approved in conjunction with cataract surgery. There are two products currently on the market: Glaukos’ iStent inject W¹ and the Hydrus Microstent from Alcon (formerly Ivantis).² Both are approved for treatment of open-angle glaucoma.

Q. What are the new CPT codes?

A. In 2022, there are two new codes for the implantation of the Hydrus with cataract surgery: 66991, 66989; the prior code, 0191T, was deleted.

66991 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.

66989 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.

Q. Is there reimbursement for the stent procedures without cataract surgery?

A. Although a CPT Category III code exists for the stand-alone procedures, there is currently no coverage because the devices are still in clinical trials and not FDA-approved as stand-alone procedures. CPT code 0671T (Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more) was added in 2022 and can be used when FDA approval is granted.

Q. What does Medicare allow for these procedures?

A. The 2022 national Medicare Physician Fee Schedules (MPFS) allowed amount for 66991 is $683 and $857 for 66989. There is no defined allowed amount in the MPFS for 0671T.

The 2022 ASC-allowed amount for 66989 and 66991 is $3,246. For a hospital outpatient department, it is $4,251. For 0671T, the allowed amounts are $1,601 and $2,121, respectively, although no claims have been paid at this time.

Q. Does Part B Medicare offer separate reimbursement for the glaucoma device?

A. No. Part B Medicare payment for the device is included in the facility reimbursement for APC 1563. On a UB-04 claim, use HCPCS code C1783 with revenue code 278 to identify the device. Do not report a HCPCS code for the device on a CMS-1500 claim. For other third-party payers, check their instructions and your contract.

Q. May gonioscopy (CPT 92020) be billed with the claim for surgery?

A. No. Gonioscopy is required during surgery to implant the device and is an incidental part of the service. CPT instructs that a code designated as a “separate procedure,” such as gonioscopy, should not be reported in addition to the code for the total procedure of which it is considered an integral component.

Q. Are CPT codes 66991 and 66989 eligible for co-management?

A. Yes, Medicare’s rules for splitting postoperative care during the 90-day global period between the surgeon and another physician apply. The CMS regulations and the professional society guidance on this issue are especially meaningful and relevant for a combined cataract and glaucoma procedure.^3-5

Q. What about bundles?

A. A number of National Correct Coding Initiative (more familiarly known as NCCI) edits apply to the new codes, including cataract as well as some glaucoma procedures. OM

REFERENCES

1. Glaukos. https://www.glaukos.com/glaucoma/products/istent-inject-w/ Accessed July 25, 2022.
2. Ivantis (now owned by Alcon). https://www.ivantisinc.com/healthcare-professionals/?selected-country=us . Accessed July 26, 2022.
3. Centers for Medicare & Medicaid Services. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/globallsurgery-icn907166.pdf . Accessed July 26, 2022.
4. American Society of Cataract and Refractive Surgery. https://ascrs.org/advocacy/regulatory/guidelines/co-management-guidelines . Accessed July 26, 2022.
5. American Academy of Ophthalmology. https://www.aao.org/ethics-detail/guidelines-comanagement-postoperative-care . Access July 26, 2022.

Suzanne L. Corcoran, COE is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .