2014 DacryoCath®
Reimbursement Coding
CPT Codes
The 5 mm DacryoCath® is used for failed DCRs.
· CPT 31239, Nasal/sinus endoscopy, surgical with dacryocystorhinostomy, the 5 mm DacryoCath® is used with endoscopic DCR
Add-on Codes
It may also be necessary to report the following
codes when performed:
CPT 68840, Probing and/or irrigation of canaliculus
CPT 68815 Probing of the nasolacrimal duct with the placement of a stent
·
· CPT 30930, Fracture of nasal turbinate(s), therapeutic
·
CPT 31231, Nasal endoscopy
CPT
92018, Ophthalmologic examination and evaluation, under general anesthesia,
with or without manipulation of globe for passive range of motion or other
manipulation to facilitate diagnostic examination; complete
Use of Modifiers
Each insurer will have the final say according to
their policies and restrictions. Modifiers may be appended to 68815 and 68816 if
the clinical circumstances justify the use of the modifier. There are certain
modifiers that can be used under appropriate clinical circumstances.
Modifier – 50 is used to indicate a bilateral
procedure.
Modifier – 58 may be used when both balloon
dilation and stent placement is done at the same operative setting. In this
scenario, the coding would be 68816 or 68815-58.
Dacryocystorhinostomy (DCR) procedure is more
extensive and is performed in cases of lacrimal stenosis where prior treatment
failed or was not fully successful. Codes to report this might include:
· CPT 31239, Nasal/sinus endoscopy, surgical; with
Dacryocystorhinostomy, the 5mm
balloon catheter is used with
Endoscopic DCR
HCPCS Codes
C-Codes are used in the outpatient setting for
Medicare only. Hospitals are encouraged to report all appropriate codes.
· HCPCS C1726, Catheter, balloon dilation, nonvascular
This code, if appropriate can be used for billing all payers and
all patient settings.
Each insurer will have the final say
according to their policies and restrictions, and may require documentation
· HCPCS A4649, Surgical supply; miscellaneous
The information provided is general information
only; it is not legal advice, nor is it advice about how to code, complete or
submit any particular claim for payment. It is always the provider’s
responsibility to determine and submit appropriate codes, charges, modifiers,
and bills for the services that were rendered. Coding and reimbursement
information is subject to change without notice. Before filing any claim,
providers should verify current requirements and policies with the payor.