Ophthalmology and Optometry Coding Alert

The addition of 66990 to the ophthalmology codes will be particularly useful for the repositioning of an intraocular lens when, for example, an endoscope is reinserted to make certain the patient has adequate capsular support for the newly implanted lens, William Rich III, MD, secretary of federal affairs for the American Academy of Ophthalmology and clinical instructor in ophthalmology at Georgetown University Hospital, told a gathering at the AAO/PAAO 2002 Joint Meeting in Orlando, Fla.

One drawback of the new ophthalmic add-on code is that it cannot be used with 66710 (Ciliary body destruction; cyclophotocoagulation). AAO sources say pressure will be applied to the CPT Editorial Panel to take into account the need for a code addressing the secondary use of an endoscope with cyclophotocoagulation.

Another new CPT modification that may affect ophthalmology coding is the addition of modifier -63 (Procedure performed on infants less than 4 kg). CPT 2003 guides coders to append this modifier when "procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician work commonly associated with these patients."

According to CPT 2003, modifier -63 can never be appended to goniotomy code 65820. The rationale for designating 65820 modifier -63-exempt is that "the additional work that modifier '-63' is intended to represent has been previously identified as an inherent element" within the procedure. CPT guidelines state further, "Modifier -63 was established to be appended only to invasive surgical procedures, and reported only for those for neonates/infants up to the 4-kg cut-off. In this population of patients there is a significant increase in work intensity, specifically related to temperature control, obtaining IV access (which may require upwards of 45 minutes), and the operation itself which is technically more difficult, especially with regard to maintenance of homeostasis."

Also of note, the five-digit modifiers previously available for interchangeable use with the hyphenated two-digit modifiers have been deleted from CPT 2003.

This won't have much of an impact on many coders' coding practice, says Marianne F. Wink, RHIT, compliance analyst and educator for the University of Rochester Medical Center in New York. She attributes the deletion of the five-digit modifiers to their infrequent use.

Mary Schwall, CPC, clinical practice specialist for the Yale School of Medicine in Connecticut, agrees: "We have always used the two-digit coding for modifiers, except when doing certain anesthesia coding, in which case it went by carrier." The change is also unlikely to affect coding systems because they can typically handle both ways of coding modifiers.

Coders had the option of reporting a five-digit code, e.g., 09922, in addition to the procedure code, in this case to indicate "Unusual procedural services," instead of appending -22 to the procedure code.

These code changes and additions are not yet finalized. The AMA CPT Advisory Committee met Nov. 14-15 to review the code changes and make its final determination on new codes for 2003.