Ophthalmology and Optometry Coding Alert

If your ophthalmologist is on the cutting edge of the technology boom, you face the daunting task of trying to code for electronic services he provides. Good news: In January your coding life may get easier with new telephone and e-visit codes.

Proposed changes: Three new proposed codes for 2008 would allow you to report the telephone E/M services your ophthalmologist performs based on the phone call length. The current telephone service codes -- 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) -- depend on the call's complexity level. You're forced to decide if the call is simple, intermediate or complex to be able to choose a code. With the new codes, you can eliminate that decision.

CPT 2008 will delete 99371-99373 and replace them with three new time-based codes and one online E/M service code.

"The new codes apply to telephone assessments provided by nonphysician healthcare professionals and have specific criteria that must be met to report the codes," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies in Powder Springs, Ga. "While these codes are primarily reported based on the time spent communicating with the patient, proximity of in-office services will also determine whether the call can be charged."

Note: The telephone call is a non-face-to-face E/M service and must only emanate from an established patient and have no relationship within seven days of a recent previous visit, surgical or diagnostic procedure, or a scheduled upcoming E/M service. CPT considers these part of a previous or upcoming visit and billable as part of the subsequent E/M code chosen.

"I think that time-based reporting versus trying to determine what is 'simple,' 'intermediate' or 'complex' is definitely a good thing," says Denae M. Merrill, CPC, physician coder for Covenant HIM in Saginaw, Mich. "You then have a clear-cut definition of what is what. A provider will then know what is important to document, and a coder will know what code is most appropriate, and there will be no room for arguing."

Additionally: Right now you have a Category III code, added in 2005, to recognize e-visit services -- 0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient). Since physicians and payers don't consider this service type "emerging technology" anymore, experts expect CPT will delete 0074T in 2008. CPT should replace that code with a Category I e-visit code for you to start reporting in January.

"The new code for 2008 reports an online E/M service provided by a nonphysician healthcare professional to an established patient," Parman says. "This code has similar requirements regarding the proximity of the telephone call to any in-office services. It appears that both the telephone services and online services would be reported only if they took the place of a visit."

Warning: Just because you have new codes doesn't mean Medicare or other carriers will pay. "New codes, or codes that are transitioned from Category III to Category I, do not mean more reimbursement," Merrill says. "It often takes the payer community time to get on the bandwagon and start reimbursing. Even then, you may find they will create guidelines to limit reimbursement to specified criterion only."

You'll have to wait until the 2008 Medicare Physician Fee Schedule comes out to see if CMS assigns relative value units (RVUs) and a fee to the Category I e-visit code. "There are a number of codes that are present in the CPT or HCPCS manual that do not have any reimbursement attached to them," Parman says.

Remember: None of these changes are official until the CPT manual comes out in November, and the new, deleted and modified CPT codes are not effective until Jan. 1. This gives your practice time to update your current superbills, charge tickets and other items in time for the New Year.