Article - Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56866)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 23, 30 Services Paid Under the Medicare Physician's Fee ScheduleArticle TextThe information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) forMicro-Invasive Glaucoma Surgery (MIGS) L37531.CPT/HCPCS code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not supersede NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.Coding Guidance:For noncomplex cataract removal with insertion of aqueous drainage system, use CPT66991.For complex cataract removal with intraocular lens implant and concomitant intraocular aqueous drainage device, use CPTcode 66989.iStent, iStent injectand Hydrusmust be performed in conjunction with cataract surgery on the same date of service and documented in the medical record.Since there is no specific CPTcode for goniopuncture or so-called microgoniotomy procedures, the unlisted CPTcode 66999 (unlisted procedure, anterior segment of the eye) should be reported in these instances.Any procedures performed which consist of single or multiple small punctures and/or injection of small amounts of viscoelastic, or other limited interventions should be reported using unlisted CPTcode 66999. Specifically, goniotomy (CPTcode 65820) should not be coded in addition to other angle surgeries, stent insertions or Schlemm canal implants or if the incision into the trabecular meshwork is minimal or simply incidental to another procedure. In order to report a goniotomy, an extensive incision of the trabecular meshwork around the eye, at the least and generally more than 3 clock hours, must have been performed. Documentation regarding the reasonable and necessary premise for the work must be present. Palmetto GBA may request additional documentation on a case-by-case basis.Utilization:Medicare may cover only 1 unit per eye, per date of service of CPTcode 66991 and 66989 for insertion of glaucoma drainage device(s) into the trabecular meshwork, when performed in conjunction with cataract surgery and when the medically reasonable and necessary criteria as stated in the LCD are met.Although more than 1 drainage device into the trabecular meshwork of a single eye on a single day of service, using an insertion tool loaded with more than 1 device, (e.g., iStentinject), may be performed, once the insertion tool is deployed within the eye, there is negligible increase in work or expense. Therefore, only 1 unit of 66991 and 66989 per eye, per day may be billed, regardless of the number of devices inserted into a single eye on the date of service.Medicare may cover only1 unit per eye, per date of service of CPTcode 0449Tfor insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45), when the medically reasonable and necessary criteria as stated in the LCD are met.CPTcode 0671T should not be billed with CPTcode 66991 or 66989 for the same beneficiary on the same date of service.Documentation Requirements:All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.