American Academy of Ophthalmology Web Site: www.aao.org
Savvy Coder: Coding & Reimbursement
Get Up to Date on These Key Changes to CPT
The AMA updates its Current Procedural Terminology (CPT) annually, with the addition of new codes and the revision or elimination of some old ones. The 2011 CPT features a number of significant changes that Eye M.D.s and their billers ought to know about.
Some updates involve the five-digit Category I codes. Other updates involve the alphanumeric Category III codes, which exist to help the CPT Editorial Panel collect data on emerging technologies, services and procedures. These data are then used to determine whether new Category I codes are needed.
Here is a quick summary of the key changes for ophthalmology. New codes are identified by the “” symbol, and codes that have undergone a change to their description are identified by the “” symbol.
Changes in Cornea
Amniotic membrane is used for ocular surface reconstruction in a variety of ways, some requiring more skill and effort than others. The 2011 CPT represents this hierarchy of services with two new codes and one revised code, and it designates a different number of work Relative Value Units (RVUs) to each of those codes:
65778 Placement of amniotic membrane on the ocular surface for wound healing; self-retaining
65779 single layer, sutured
65780 Ocular surface reconstruction; amniotic membrane transplantation, multiple layers
(Please note—CPT instructs that neither 65778 nor 65779 should be billed in conjunction with any of the following three codes: 65430 Scraping of cornea, 65435 Removal of corneal epithelium or 65780 Ocular surface reconstruction.)
To bill for placement of amniotic membrane using tissue glue, use 66999 Unlisted procedure, anterior segment of eye.
Changes in Glaucoma
The 2011 CPT eliminated two Category III codes for canaloplasty—0176T and 0177T—and added two new Category I codes:
66174 Transluminal dilation of aqueous outflow canal; without retention of device or stent
66175 with retention of device or stent
There also is a new Category III code:
0253T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space (Glaukos shunt).
Code 0253T was created to specifically address the route of aqueous egress into the suprachoroidal space. When looking for it in the CPT listings, you should note that it is out of sequence. The entry for 0253T appears between 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork and 0192T external approach.
Codes Eliminated in Retina
Category III codes are reviewed every five years and are eliminated if there is insufficient support for their retention. The 2011 CPT, for example, eliminated Category III codes 0016T Destruction of localized lesion of choroid (e.g., choroidal neovascularization), transpupillary thermotherapy and 0017T Destruction of macular drusen, photocoagulation.
Instead of coding 0016T and 0017T for those two procedures, the CPT instructs you to use 67299 Unlisted procedure, posterior segment.
Changes in Testing Services
The 2011 CPT eliminated code 92135 Scanning computerized ophthalmic diagnostic imaging, posterior segment, (e.g., scanning laser) with interpretation and report, unilateral, replacing it with three new codes:
92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
(Please note—CPT indicates that you should not report both 92133 and 92134 at the same patient encounter.)
What prompted these changes in OCT coding? CMS is charged by law to identify codes with the highest rate of growth and then have them reviewed to see if they have been misvalued. The dramatic increase in the number of OCT procedures being billed each year put 92135 in the crosshairs of the CMS. The division into an optic nerve code and a retina code was prompted by the distinctly different uses for the service and will aid clinicians in reporting different services. It was also decided that the service’s unilateral designation should be discontinued because claims data suggested that it was being done bilaterally in the majority of cases.
New Codes in Telemedicine
You should be aware of two new telemedicine codes:
92227 Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral
92228 Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral
(Please note—CPT instructs that these two new codes should not be submitted with each other, nor should they be submitted with codes 92002–92014, 92133, 92134 or 92250. And they should not be submitted with E&M of the single organ system, the eye, 99201–99350.)
NCCI Edits Due in April
National Correct Coding Initiative (NCCI) edits affecting the new codes will be published in version 17.1, effective April 1.
The NCCI edits lists pairs of codes that the CMS deems not separately payable when performed in the same operative session.