Can You Bill 66984 and 65820 Together?

Medical coding serves as the language of healthcare, translating medical services into standardized codes for billing and record-keeping. The accurate application of these codes, particularly Current Procedural Terminology (CPT) codes, is fundamental for proper reimbursement and compliance. When multiple procedures are performed during the same patient encounter, determining whether they can be billed together requires careful consideration of coding guidelines. This article explores the specific billing question concerning CPT codes 66984 and 65820, detailing their individual descriptions and the rules governing their combined submission.

Understanding the Procedures

CPT code 66984 describes extracapsular cataract removal with insertion of an intraocular lens prosthesis. This procedure, often performed using techniques like phacoemulsification, restores vision by replacing a cloudy natural lens with an artificial one, addressing conditions like age-related or traumatic cataracts.

CPT code 65820 represents a goniotomy, which is an incision procedure on the anterior chamber of the eye. This surgical intervention is commonly performed to relieve inner eye pressure, primarily in patients with glaucoma. The procedure involves making an incision into the trabecular meshwork to improve the drainage of aqueous humor, thereby reducing intraocular pressure. While both procedures involve the eye, they target distinct conditions; 66984 addresses lens opacity, and 65820 addresses fluid drainage to manage glaucoma.

National Correct Coding Initiative Edits

The National Correct Coding Initiative (NCCI) plays a significant role in preventing improper payments by identifying code pairs that should not be reported together. These edits are designed to ensure that Medicare and other payers do not make duplicate payments for services that are considered components of a more comprehensive procedure or are mutually exclusive.

However, CPT codes 66984 (cataract surgery) and 65820 (goniotomy) are not currently bundled by NCCI edits. This means they can be billed together without a modifier to bypass a bundling edit.

Appropriate Modifier Application

Even when NCCI edits do not bundle two procedures, modifiers may still be necessary to accurately describe the services rendered. Modifiers provide additional information about a service or procedure, clarifying that it was distinct or independent from other services performed on the same day. For procedures performed concurrently, especially those not typically bundled but still performed in the same operative session, a modifier can prevent claims denials by indicating the distinct nature of each service.

Modifier -59, “Distinct Procedural Service,” is commonly used to indicate that a procedure or service was separate from other non-Evaluation and Management (E/M) services. Its application is appropriate when procedures are performed at different anatomic sites, during different sessions, or represent genuinely independent interventions.

The Centers for Medicare & Medicaid Services (CMS) also introduced more specific X{EPSU} modifiers, such as -XU, to provide greater detail. While -59 remains valid, CMS encourages the use of these more specific X modifiers when applicable. Applying a modifier, such as -XU, would signal that the goniotomy was a distinct, non-overlapping service performed alongside the cataract extraction, even if not explicitly bundled by NCCI.

Supporting Documentation for Separate Billing

Comprehensive and accurate medical record documentation is important to justify billing for multiple procedures. When CPT codes 66984 and 65820 are submitted together, the patient’s record must clearly support the medical necessity for both interventions. This includes distinct diagnoses for each procedure, substantiating why both a cataract removal and a goniotomy were required for the patient’s care.

The operative report should provide detailed descriptions of both procedures, emphasizing their independent nature. This might include documenting separate incisions, distinct surgical fields, or different surgical approaches for each procedure. Pre-operative findings, such as documented cataract severity and elevated intraocular pressure necessitating goniotomy, must also be clearly recorded. If both procedures are performed on the same eye, the surgeon’s notes should explicitly articulate the rationale for performing both simultaneously, affirming that the goniotomy was a significant, extensive procedure and not merely incidental to the cataract surgery.