Article

Coding & Reimbursement

ECP coding and billing update

Endoscopic cyclophotocoagulation isn’t a new surgical procedure, although advances in the technology continue to occur.

Coding and billing rules change, though, so here is a review.

Q. What is endoscopic cyclophotocoagulation (ECP)?

A. ECP is a cyclodestructive procedure. It uses a microendoscope with three elements: an image guide, a light source and a laser. The surgeon has direct visualization of the ciliary processes, which enables precise delivery of laser energy and limits damage to the underlying ciliary body and neighboring tissue.

ECP minimizes the disadvantages of trans-scleral cyclodestructive procedures, while maximizing the advantage of ablating the ciliary body epithelium to decrease IOP.

ECP is indicated for treatment of glaucoma in patients who have failed with conventional topical and systemic medications, previous laser photocoagulation, trabeculectomy and other filtering procedures, cyclocryotherapy or other cyclodestructive procedures.1

Q. Does ECP have FDA approval?

A. Yes, the Uram Ophthalmic Laser Endoscope was approved by the FDA in 1991.2

Q. What CPT codes should be used for ECP?

A. This depends on whether the procedure was performed before or after Jan. 1, 2020.

For procedures prior to Jan. 1, 2020, 66711 is the exclusive code for ECP. Codes 66982 or 66984 were also used when performed concurrently with cataract surgery.

Effective Jan. 1, 2020, 66711 is used only when ECP is not performed at the same time as cataract surgery. If ECP is performed with cataract surgery, new codes 66987 and 66988 apply.

  • 66711: Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
  • 66987: 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 endoscopic cyclophotocoagulation
  • 66988: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation

Furthermore, codes 66982 and 66984 specifically added the phrase “without endoscopic cyclophotocoagulation.”3

Q. What should be documented in the chart?

A. Reimbursement for ECP (with or without cataract) depends on medical necessity. The operative report should contain a brief sentence or two that describes the indication for surgery. A description of why the surgery was needed is very useful for the ASC or HOPD that might not have any chart note from the clinic.

The operative report for cataract surgery with concurrent ECP sometimes suffers from incompleteness due to the use of a uniform and repetitive chart note for the cataract surgery that omits mention of the glaucoma procedure. This may occur when a template is used for the operative report, rather than a unique dictation.

The billers for the surgeon and the facility, when presented with a chart that only describes cataract surgery, will not bill for the ECP.

Q. Are there limitations to insurance coverage?

A. Currently, no national or local coverage Medicare policies pertaining to ECP exist. Unlike temporary Category III codes, claims for reimbursement are not typically a problem for ECP. However, there are codes that may not be billed together. According to the Jan. 1, 2020, National Correct Coding Initiative edits, 66711 is bundled with a large number of noncataract procedures and many other glaucoma procedures.4

Q. What are the 2020 Medicare reimbursement rates for ECP?

A. For CY 2020, the national Medicare payment rates are shown in the Table below.

TABLE
CPT Surgeon5 ASC6 HOPD6
66711 $514 $1,013 $2,022
66987 * $2,393 $3,818
66988 * $2,393 $3,818
*MAC makes individual determination

No RVUs are assigned to 66987 or 66988, so the Medicare Administrative Contractors (MACs) are required to determine the payments to surgeons.

Medicare facility reimbursement for the new CPT codes rose dramatically in 2020 compared to the prior regime of billing for 66711 with 66982 or 66984. In ASCs, the national allowable for 66987 and 66988 each are set at $2,393, a 63% increase over 2019. For HOPDs, the allowables for 66987 and 66988 each are set at $3,818 — a 99% increase, primarily due to the effect of the comprehensive ambulatory payment classification (C-APC). OM

REFERENCES

  1. US Food and Drug Administration. 510(k) Summary for E2 Microprobe Laser and Endoscopy System. K042918. Oct. 18, 2004. https://www.accessdata.fda.gov/cdrh_docs/pdf4/K042918.pdf . Accessed Jan. 27, 2020.
  2. U.S. Food and Drug Administration. 510(k) premarket notification for Uram Ophthalmic Laser Endoscope. K910532 05/28/1991. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K910532 . Accessed Jan. 27, 2020.
  3. The American Medical Association. CPT Professional 2020. Optuminsight Inc; Revised edition: Sept. 23, 2019.
  4. Centers for Medicare and Medicaid Services. PTP Coding edits. https://tinyurl.com/v9jj3gd . Accessed Jan. 27, 2020.
  5. Federal Register. CMS-1715-F and IFC. Published Nov. 15, 2019. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1717-FC . Accessed Jan. 27, 2020.
  6. CMS-1715-FC. 84 FR 61142. Published Nov. 12, 2019. 2020 NFRM Addendum B. https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other . Accessed Jan. 27, 2020.