Ophthalmology and Optometry Coding Alert

You may still be poring through your 2010 CPT manual, but the new edition of Correct Coding Initiative (CCI), effective Jan. 1, could change how you report your ophthalmologist's injection procedures.

The CCI released version 16.0 in early December, revealing 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a Dec. 8 announcement.

One big change ophthalmology coders will notice is that CCI 16.0 bundles new spinal injection codes 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic, single level) and 64493 (... lumbar or sacral, single level) into nearly all of the Eye and Ocular Adnexa surgery codes (65091-68899).

CPT introduced the new paravertebral facet injection codes for 2010 to replace deleted codes 64470-64476 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...). Likewise, the CCI 16.0 bundles replace previous bundles with the old codes, which have been in place since 2002.

CCI marks most of the code pairs with modifier indicator "0," which prevents you from reporting the two codes separately under any clinical circumstances.

Good news: These edits will probably not make life much worse for ophthalmology coders, because ophthalmologists are unlikely to perform spinal injections, notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. Most of the new CCI bundles affect codes that debuted in CPT 2010, like 64490 and 64493.

Another new addition to CCI bundles the eye exam codes, 92002-92014 (Ophthalmological services: medical examination and evaluation ...), into the "Welcome to Medicare" exam code G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). That code replaced deleted code G0344 (...services limited to new beneficiary during the first six months of Medicare enrollment) in 2009, but CCI has not gotten around to updating the bundle until now.

These code pairs are marked with modifier indicator "1" which allows both services (G0402 and the eye codes) to be reported together when appropriate, says Mac.

Learn more: The full list of CCI edits will be available on the Medicare Web site, at www.cms.hhs.gov/NationalCorrectCodInitEd.