Ophthalmology and Optometry Coding Alert

Certain states now require this new procedure.

If you’re used to including post-operative visits in the eye surgeries your physician provides, then you’re going to have to make a shift — and soon, as Medicare has already changed the rules, effective July 1, 2017. Read on to find out if this change includes your practice.

Get the 99024 Scoop

When your ophthalmologist sees a traditional Medicare patient after a surgery, you will need to report 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a post-operative period for a reason[s] related to the original procedure) for each routine postoperative visit within that surgery’s global period.

Who this affects: You will have to adopt this new rule if your practice has ten or more practitioners and is located in one of the nine specified states:

• Florida,
• Kentucky,
• Louisiana,
• Nevada,
• New Jersey,
• North Dakota,
• Ohio,
• Oregon, and
• Rhode Island.

Rationale: You can thank the Medicare Access and CHIP Reauthorization Act (MACRA) for this change. CMS intends to assess how often physicians performing surgeries actually see patients for postoperative visits. That way, they can potentially revalue the fees for global codes starting in 2019.

You can find the complete list of all affected CPT^® codes here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Codes-for-Required-Global-Surgery-Reporting-CY-2017.zip.

Eye practice highlights: Although the following list does not include all of the codes impacted by the change, below is a sampling of the CPT^® codes commonly reported by ophthalmologists that are affected by this change:

• 65756 — Keratoplasty (corneal transplant); endothelial
• 66170 — Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
• 66179-66180 — Aqueous shunt to extraocular equatorial plate reservoir, external approach
• 66761 — Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)
• 66821 — Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages)
• 66982 — Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage 
• 66984 — Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)  
• 67036 — Vitrectomy, mechanical, pars plana approach

Resource: For more detailed information, see the CMS website for the recording, transcript, and slide deck of a CMS hosted call from April 25: >>https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2017-04-25-Global-Surgery.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending.