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Goniotomy procedures performed in conjunction with insertion of a glaucoma drainage device is considered not reasonable and necessary

First Coast has detected an upward trend in the inappropriate billing of code combination 65820 reported with either 66989, 66991 or 0671T. This article is intended to remind providers of the instruction provided in the local coverage determination (LCD) L38233 Micro-invasive glaucoma surgery (MIGS) and the companion billing and coding article A56647. 

Codes defined: 

  • 65820 Goniotomy defined as trabecular meshwork is incised and/or excised with a blade or other surgical instrument for at least several clock hours to create an opening into Schlemm canal from the anterior chamber, via an internal approach through the anterior chamber.
  • 66989 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemul­sification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulor­rhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (e.g., trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.
  • 66991 Extracapsular cataract re­moval with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); with insertion of intraocular (e.g., trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.

As of Jan. 1, 2022, the Group 3 code below is considered not reasonable and necessary and is non-covered. 

  • 0671T is defined as insertion of anterior seg­ment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more.

Per the LCD: Goniotomy procedure performed in conjunction with the insertion of a glaucoma drainage device is considered not medically reasonable and necessary. Routine performance of goniotomy with insertion of a glaucoma drainage device may be subject to focused medical review.