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  • Important Coding Updates

Blue Cross Blue Shield of Michigan revised its policy "Aqueous Shunts and Stents for Glaucoma

"On November 1, 2013 to and now covers implantation of the iStent device which is described by CPT Code 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork). The policy states that "The effectiveness of this device (i.e., the iStent device) has been demonstrated only in patients with mild to moderate open-angle glaucoma who are currently treated with ocular hypotensive medication and who are undergoing concurrent cataract surgery for visually significant cataract." The policy also lists exclusions for which the iStent is not considered medically necessary. These exclusions are consistent with the FDA labeling for the device. As with all commercial insurance plans, providers should request a prior authorization from BCBS of Michigan for all iStent cases. The link to the policy is:

https://www.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=2059131

  • WPS/Medicare has made a decision for coverage of the IStent procedure represented by code 0191T
It will be added to the Category III codes LCD, effective for reimbursement 02/01/2013. This is what has been added to the Category III Codes LCD:

An anterior segment aqueous drainage device, utilizing the interal approach. For use in combination with cataract surgery to reduce pressure inside the eye (intraocular pressure) in adult patients with mild or moderate open- angle glaucoma on medication. ICD-9-CM code 365.71 or 365.72 should be used to support medical necessity.

  • BCBSM has announced the following updates in benefits for blepharoplasty and blepharoptosis procedures:

    • 15822 Blepharoplasty - upper eyelid
    • 15823 Blepharoplasty with excessive skin weighing down eyelid

Blepharoplasty is considered reconstructive, not cosmetic if the following criteria are met: The excessive skin redundancy causes visual impairment that results in a 30% or 12 degree loss of superior visual field that is corrected when the eyelid is taped. The medical record should include visual field testing reports in both taped and untaped positions, high quality color photographs demonstrating the head held in an erect position with eyes open and focused straight ahead. Views should reveal the full-face anterior position, as well as the right and left lateral views with straightforward gaze.

    • 67900 Repair of brow ptosis (supraciiary, mid-forehead or coronal approach)
    • 67901 Repair of blepharoptosis; frontalis muscle technique with suture or other materials (e.g.: banked fascia) 67902 Autologous fascial sling (includes obtaining fascia)
    • 67903 Levator (tarso) resection or advancement, internal approach
    • 67904 Levator (tarso) resection or advancement, external approach
    • 67906 Superior rectus technique with fascial sling (includes obtaining fascia)
    • 67908 Conjuntivo-tarso-Muller's muscle-levator resection (e.g.: Fasanella-Servat type)


Thomas M. Aaberg, Jr., MD
President

Chairman of the Board

MiSEPS Executive Offices
15415 East Jefferson Ave
Grosse Pointe Park, MI 48230
Phone: (313) 823-1000
Fax: (313) 822-4233
admin@miseps.org

Gregory J. Chancey , MBA
Executive

Joan M. LaBranche
Executive Assistant


Gregory J. Chancey, MBA
Executive Vice President
Chief Executive Officer


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