Ophthalmology and Optometry Coding Alert

Although you’ve probably thought to reference your payer policies regarding new CPT^® codes, many insurers also revise existing policies when the calendar turns. When examining your insurers’ coverage decisions, don’t forget to check for updates as well as new policies.

For example, United Healthcare recently issued dozens of updates to coding directives, some of which greatly impact ophthalmology coders.

In one such policy that UHC revised in December, the insurer updated its policy on surgical treatments for glaucoma. The policy now states, “Canaloplasty is proven and medically necessary for treating primary open-angle glaucoma.” Although Medicare payers were already reimbursing canaloplasty, some other insurers considered it experimental, so the new directive could help your reimbursement in 2017. “It’s a win for ophthalmology practices and better aligns with Medicare and other payers,” says Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CPC-I, CHPSE, vice president of strategic development with Eye Care Leaders.

A second UHC update changes the brow ptosis guidelines to now require documentation of the procedure performed (e.g., supra-ciliary, coronal direct brow, etc.) rather than simply documenting “brow ptosis.” This change is one that you should definitely communicate to the physicians in your practice to continue collecting for this service. “Any time a practice performs a service or procedure that some may consider cosmetic, documentation should clearly state the medical necessity,” Buckholtz says. “This is a good reminder for those practices with plans already in place and a quick boost for those that have not been documenting it well.”

Tip: Keep your eye on payer policies to ensure that you take note of any important changes and updates that may affect your coding and billing procedures.