LCD Reference Article Billing and Coding Article

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

A56866

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56866
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
Article Type
Billing and Coding
Original Effective Date
08/15/2019
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Title 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 Schedule

Article Guidance

Article Text

The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for Micro-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 CPT® 66991.

For complex cataract removal with intraocular lens implant and concomitant intraocular aqueous drainage device, use CPT® code 66989.

iStent®, iStent inject® and Hydrus® must be performed in conjunction with cataract surgery on the same date of service and documented in the medical record.

Since there is no specific CPT® code for goniopuncture or so-called microgoniotomy procedures, the unlisted CPT® code 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 CPT® code 66999. Specifically, goniotomy (CPT® code 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 CPT® code 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., iStent inject®), 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 only 1 unit per eye, per date of service of CPT® code 0449T for 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.

CPT® code 0671T should not be billed with CPT® code 66991 or 66989 for the same beneficiary on the same date of service.

Documentation Requirements:

  1. 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.
  2. 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.
  3. 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.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

The CPT® codes are considered medically necessary when the indications of coverage in the Micro-Invasive Glaucoma Surgery (MIGS) L37531 Local Coverage Determination (LCD) are met for the utilized anterior segment drainage device. A reasonable and necessary standard must be met for the surgical cataract treatment. The 90 day global periods apply.

Group 1 Codes
Code Description
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
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

Group 2

(1 Code)
Group 2 Paragraph

The CPT® codes in Group 2: Codes are considered medically necessary when the indications of coverage in the Micro-Invasive Glaucoma Surgery (MIGS) L37531 LCD are met. The 90 day global periods apply.

Group 2 Codes
Code Description
0449T INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; INITIAL DEVICE

Group 3

(3 Codes)
Group 3 Paragraph

The CPT® codes in Group 3 are considered not medically necessary.

Group 3 Codes
Code Description
0253T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUPRACHOROIDAL SPACE
0450T INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; EACH ADDITIONAL DEVICE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
0474T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITH CREATION OF INTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUPRACILIARY SPACE

Group 4

(1 Code)
Group 4 Paragraph

CPT® code 0671T will be reviewed individually to determine medical necessity.

Group 4 Codes
Code Description
0671T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE INTO THE TRABECULAR MESHWORK, WITHOUT EXTERNAL RESERVOIR, AND WITHOUT CONCOMITANT CATARACT REMOVAL, ONE OR MORE
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(9 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
H40.1111 Primary open-angle glaucoma, right eye, mild stage
H40.1112 Primary open-angle glaucoma, right eye, moderate stage
H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage
H40.1121 Primary open-angle glaucoma, left eye, mild stage
H40.1122 Primary open-angle glaucoma, left eye, moderate stage
H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage
H40.1131 Primary open-angle glaucoma, bilateral, mild stage
H40.1132 Primary open-angle glaucoma, bilateral, moderate stage
H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage

Group 2

(48 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
H40.1111 Primary open-angle glaucoma, right eye, mild stage
H40.1112 Primary open-angle glaucoma, right eye, moderate stage
H40.1113 Primary open-angle glaucoma, right eye, severe stage
H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage
H40.1121 Primary open-angle glaucoma, left eye, mild stage
H40.1122 Primary open-angle glaucoma, left eye, moderate stage
H40.1123 Primary open-angle glaucoma, left eye, severe stage
H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage
H40.1131 Primary open-angle glaucoma, bilateral, mild stage
H40.1132 Primary open-angle glaucoma, bilateral, moderate stage
H40.1133 Primary open-angle glaucoma, bilateral, severe stage
H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage
H40.1211 Low-tension glaucoma, right eye, mild stage
H40.1212 Low-tension glaucoma, right eye, moderate stage
H40.1213 Low-tension glaucoma, right eye, severe stage
H40.1214 Low-tension glaucoma, right eye, indeterminate stage
H40.1221 Low-tension glaucoma, left eye, mild stage
H40.1222 Low-tension glaucoma, left eye, moderate stage
H40.1223 Low-tension glaucoma, left eye, severe stage
H40.1224 Low-tension glaucoma, left eye, indeterminate stage
H40.1231 Low-tension glaucoma, bilateral, mild stage
H40.1232 Low-tension glaucoma, bilateral, moderate stage
H40.1233 Low-tension glaucoma, bilateral, severe stage
H40.1234 Low-tension glaucoma, bilateral, indeterminate stage
H40.1311 Pigmentary glaucoma, right eye, mild stage
H40.1312 Pigmentary glaucoma, right eye, moderate stage
H40.1313 Pigmentary glaucoma, right eye, severe stage
H40.1314 Pigmentary glaucoma, right eye, indeterminate stage
H40.1321 Pigmentary glaucoma, left eye, mild stage
H40.1322 Pigmentary glaucoma, left eye, moderate stage
H40.1323 Pigmentary glaucoma, left eye, severe stage
H40.1324 Pigmentary glaucoma, left eye, indeterminate stage
H40.1331 Pigmentary glaucoma, bilateral, mild stage
H40.1332 Pigmentary glaucoma, bilateral, moderate stage
H40.1333 Pigmentary glaucoma, bilateral, severe stage
H40.1334 Pigmentary glaucoma, bilateral, indeterminate stage
H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage
H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage
H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage
H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage
H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage
H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage
H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage
H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage
H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage
H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage
H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage
H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All other ICD-10-CM codes not listed under “ICD-10-CM Codes that Support Medical Necessity” will be denied as not medically necessary.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.


Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2022 R7

Under Article Text: Utilization added fourth paragraph to read “CPT® code 0671T should not be billed with CPT® code 66991 or 66989 for the same beneficiary on the same date of service.” Under CPT/HCPCS Codes Group 3: Codes removed 0671T. Under CPT/HCPCS Codes added Group 4: Paragraph verbiage to read “CPT® code 0671T will be reviewed individually to determine medical necessity,” and under CPT/HCPCS Codes Group 4: Codes added 0671T. This revision is retroactive effective for dates of service on or after 10/1/22.

08/01/2022 R6

Under Article Text subheading Coding Guidance replaced CPT® code 69999 with CPT® code 66999 in the fourth and fifth paragraphs. The addition of CPT® code 69999 was done in error. CPT® was inserted throughout the article where applicable. Formatting was corrected throughout the article.

08/01/2022 R5

Under Article Text added additional verbiage following the first paragraph. Under CPT/HCPCS Codes Group 1: Paragraph added the last sentence. Under CPT/HCPCS Codes Group 2: Paragraph revised the first sentence to read, “The CPT® codes in Group 2: Codes are considered medically necessary when the indications of coverage in the Micro-Invasive Glaucoma Surgery (MIGS) L37531 LCD are met” and added the second sentence. Under CPT/HCPCS Codes Group 3: Codes added 0474T and 0253T.

01/01/2022 R4

Under CPT/HCPCS Codes Group 1: Paragraph deleted the verbiage “Group 1: Codes” and added “the utilized anterior segment drainage device. A reasonable and necessary standard must be met for the surgical cataract treatment” at the end of the paragraph. Under CPT/HCPCS Codes Group 1: Codes added codes 66989 and 66991, and deleted codes 0191T and 0376T. Under CPT/HCPCS Codes Group 3: Codes added code 0671T. This revision is due to the Annual CPT/HCPCS update and is effective on 1/1/22.

02/20/2021 R3

Under ICD-10 Codes that Support Medical Necessity – Group 2 Codes added codes H40.1211, H40.1212, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232, H40.1233, H40.1234, H40.1311, H40.1312, H40.1313, H40.1314, H40.1321, H40.1322, H40.1323, H40.1324, H40.1331, H40.1332, H40.1333, H40.1334, H40.1411, H40.1412, H40.1413, H40.1414, H40.1421, H40.1422, H40.1423, H40.1424, H40.1431, H40.1432, H40.1433, and H40.1434.

02/10/2020 R2

Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Micro-Invasive Glaucoma Surgery (MIGS) L37531 LCD and placed in this article. Under CPT/HCPCS Codes Group 1: Codes added CPT® code 0376T and deleted this code from the CPT/HCPCS Codes Group 3: Codes section. CPT® was inserted throughout the article where applicable.

08/15/2019 R1

All coding located in the Coding Information section has been removed from the related Micro-Invasive Glaucoma Surgery (MIGS) L37531 LCD and added to this article.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37531 - Micro-Invasive Glaucoma Surgery (MIGS)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
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Keywords

  • MIGS
  • Micro-Invasive Glaucoma Surgery