Ophthalmology and Optometry Coding Alert

If your ophthalmologist performs retina surgeries, prepare for a new wave of coding rules come January.

CPT 2008 will offer you approach-specific codes for these procedures, and HCPCS 2008 will bring a J code for Lucentis.

CPT 2008 will delete 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) and add three new codes for vitrectomy procedures, accord-ing to insiders. The new codes will specify the method your ophthalmologist uses to remove the retinal membrane.

"With the deletion of code 67038, doctors will need to review the new codes (67041-67043) and become familiar with the different classifications for vitrectomy," says Regan Bode, CPC, CPC-EM, ACS-EM, OCS, product manager for Custom Coding Books in Seattle and Eyecoding.net founder.

How it works: The descriptors for the three new codes will all describe a mechanical vitrectomy but will then include specific information about the rest of the procedure your ophthalmologist performs. You'll choose your code based on the retinal membrane removal method and the level of surgical intensity. "In general, the new codes seem to cover all the scenarios under which we would have used 67038 and are good distinctions," says Karen Bartrom, CPC, coder with Vitreo-Retinal Consultants in Indianapolis.

Old way: Now CPT offers you only 67038 for a vitrectomy with retinal membrane stripping.

Tip: Coders will have to rely on solid physician documentation to be able to choose the appropriate code based on the surgical method.

Hint: Your updated 2008 CPT manual and the Correct Coding Initiative (CCI) should list the codes that you won't be able to report along with these codes.

You can also look forward to a new code for complex retinal detachment. The new retinal detachment code "classifies repair of a complex retinal detachment with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens," Bode says.

In addition: CPT 2008 may also add new codes for balloon catheter tear duct dilation, ocular photoscreening exams and retinopathy treatment in preterm infants. Stay tuned to Ophthalmology Coding Alert for details on these new codes.

HCPC heads-up: In January, you'll have a J code specifically for Lucentis, sources say. Gone will be the days of using unclassified codes J3490 (Unclassified drugs) or J3590 (Unclassified biologics) for the drug supply.