NCCI Edits Impact Canaloplasty and Goniotomy Coding on July 1, 2020

New NCCI edits go into effect on July 1, 2020, for the code combination of 66174 (Transluminal dilation of aqueous outflow canal; without retention of device or stent) and 65820 (Goniotomy). They will be “mutually exclusive”, meaning the codes cannot reasonably be billed on the same eye in the same surgical session.

Before July 1, 2020, there were no NCCI edits bundling these two codes, which means offices and ASCs could bill both codes together. However, the American Medical Association (AMA), the publisher of CPT, via their publication CPT Assistant, opined in two separate opinions in December 2018 and September 2019, that the codes should not be billed together on the same eye, on the same date.  NCCI has now made a new edit to bundle these two codes together.

Based on the new edit, while you might choose to perform the procedures together, you are only allowed to bill for 66174.  This edit will not be retroactive but will start with dates of service on July 1, 2020 or later.

There are financial impacts for both physicians and facilities.

Check with your non-Medicare payers, as NCCI edits are generally accepted and followed, but other payers aren’t obligated to do so (in part or full).

We are available and happy to assist you with issues such as this and other topics related to eye care during this public health emergency.  Stay safe. (800) 399-6565

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