Ophthalmology and Optometry Coding Alert

Ophthalmologists should be pleased by the recommended revisions of the Evaluation and Management (E/M) services codes that the American Medical Associations CPT Editorial Panel sent to the Health Care Financing Administration (HCFA) last month. Not only do these revisions seek to reduce quantification, or counting bulletssomething all physicians will appreciate (although it remains to be seen whether HCFA will follow through on this, since HCFA likes quantification) but they also include 20 elements in the eye exam, which will make it easier for ophthalmologists to meet the requirements for a comprehensive examination. (See insert for list of elements.)

But it was a close call: When the revisions were
issued during the first week of June, the eye exam included only 16 elements. While that is still an improvement over the current 12 in the 1997 guidelines, it wasnt enough for the American Academy of Ophthalmology (AAO), which immediately appealed to the AMA CPT Editorial Panel. After less than a week, the recommended revisions were changed to append the additional elements. In a June 11 statement published on the AAOs website, H. Dunbar Hoskins, Jr., MD, executive vice president of the Academy, said the amended list of elements is a direct result of the hard work and dedication of the AAO members who contacted AMA to share their thoughts concerning the clinical appropriateness of these issues. Michael Repka, MD, the AAOs advisor to the CPT Editorial Panel, and William Rich, MD, the AAOs Secretary of Federal Affairs, provided the necessary clinical input to the panel.

The AAO will continue to work with HCFA to make sure that these corrections are carried through to the guidelines final implementation, Hoskins concludes.
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How did the exam end up with 20 instead of 16
elements? First, conjunctivae and sclera had been combined into one element. Secondly, there were only two ophthalmoscopic examinations instead of five: the optic disc(s) and posterior segment or macula through undilated pupils or with pupillary dilation (this became three separate elements); and the retinal periphery with pupillary dilation. And thirdly, the revision added an ophthalmoscopic examination of the retinal vessels.

As mentioned above, it will be several months before HCFA decides exactly what these exams will look like, and also to what extent counting will figure in. So for now, continue using the 12 elements listed in the 1997 CPT guidelines, and watch for updates in future issues of OPC.