Each year, the Academy’s Annual Meeting showcases new medical technologies and procedures. While many of these raise the quality of patient care, they also raise the question of how you document services that don’t yet have their own Category I codes.
The answer may lie within a set of codes that practices often forget about—the Category III codes. These were first introduced on Jan. 1, 2002, as a set of temporary codes to document new services. They are five-character alphanumeric codes, with the alpha-character appearing last.
Purpose is to facilitate data collection. Category III codes allow data collection for payers. Since use of unlisted codes does not provide the opportunity for collection of this data, Category III codes—if they’re available—must be reported instead of unlisted codes.
Payment depends on policies of payers and local Medicare carriers. No relative value units (RVUs) are assigned to these codes on a national level. Insurance companies have the option to cover or not cover these codes. However, Medicare carriers may develop a specific coverage policy. Category III codes may or may not receive a Category I code in the future. So unless your payer has a coverage policy, it’s best to obtain an Advance Beneficiary Notice (ABN) from your Medicare patients and append modifier –GA to the Category III code.
Published in January and July of each year. Because the results are published semiannually, the most current Category III codes are not always available in the CPT book. The following are most relevant to ophthalmology.
0099T Implantation of intrastromal corneal ring segments.
0123T Fistulization of sclera for glaucoma, through ciliary body.
0173T Monitoring of intraocular pressure during vitrectomy surgery. (List separately in addition to code for primary procedure.)
0176T Transluminal dilation of aqueous outflow canal; without retention of device or stent. Note: Use 0176T for canaloplasty.
0177T Transluminal dilation of aqueous outflow canal; with retention of device or stent. Note: Use 0177T for canaloplasty.
0181T Corneal hysteresis determination, by air impulse stimulation, bilateral, with interpretation and report.
0187T Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral. Note: This is appropriate when coding for anterior segment, rather than posterior segment optic nerve evaluation.
0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach. Note: Use 0191T for the iStent.
0192T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach. Note: This was released on Jan. 1, 2008, and implemented on July 1, 2008. It should be used for the supply of the Express shunt and Aquaflow. Prior to July 1, these should have been coded with 66170 or 66172, not 66810. While the ambulatory surgical center and/or hospital outpatient department will be paid for 0192T, the surgeon may not be paid by the insurance company. CPT code 66180 should still be submitted with the Baerveldt, Ahmed and Molteno shunts.
0198T Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report. Note: This was released July 1, 2008, and will be implemented Jan. 1.
Five codes that should no longer be used. Codes 0016T, 0017T, 0100T, 0124T and 0190T have no current application.
Five Types of CPT Code
Documenting services can require knowledge of five different types of Current Procedural Terminology (CPT) codes.
Category I, Level I codes, such as 99214, are the most familiar. There are approximately 7,000 of these five-character numeric codes. They include all levels of exam, special testing and surgical procedures.
Category I, Level II codes, such as V2788, represent the Health Care Financing Administration Common Procedure Coding System (HCPCS). These five-character alphanumeric codes are used to document supplies, injectable solutions, glasses, contact lenses and screening (e.g., the glaucoma detection benefit).
Category I, Level III codes are assigned by Medicare carriers and therefore vary from region to region. They are used to describe procedures and services not identified in Category I, Levels I or II. These five-character alphanumeric codes begin with the letters W through Z. Currently there are no Category I, Level III codes that affect ophthalmology.
Category II codes, such as 0014F, are used to document quality measures for the Physician Quality Reporting Initiative (PQRI). In 2009, there will be a 2 percent bonus if you successfully participate in this program. For a list of current codes and the three possible new codes, visit www.aao.org/pqri.
Category III codes, such as 0198T, are used to document emerging technologies, services and procedures. They are five-character alphanumeric codes that end with the letter T. These tracking codes were introduced so data could be collected on new tests and services. This information helps the CPT Editorial Panel and its advisors determine whether new Category I codes are required.