Ophthalmology and Optometry Coding Alert

January is the time to implement new and revised CPT codes, and ophthalmology practices will have a lot to digest this year, including a new retinal detachment code and several new Category III codes for services such as intraocular pressure monitoring during vitrectomies.

Don't delay: These new codes take effect on Jan. 1, and CPT expects coders to start using them right away. Remember that there is no longer a grace period for you to get used to the new codes.

Good news: The 2008 changes should be beneficial for your practice. "I think most of these codes give a more specific definition, and it appears that there is room for a higher reimbursement when a more complex procedure is performed by the physician," says Katie Stillman, coding specialist for EYE Q Vision in Fresno, Calif. "The codes appear to have the ability to recognize the higher levels now without having to submit additional documentation."

Beginning in January, you can count on a more appropriate code for complex retinal detachment repairs. CPT 2008 adds 67113 (Repair of complex retinal detachment [e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees], 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).

How it works: As the code descriptor specifies, you should report 67113 for complex retinal detachment repairs that include a vitrectomy and neovascular membrane peeling.

"So often a complex retinal detachment is not billed to get the fullest reimbursement," Stillman says. "Our retinal specialist performs a lot of these procedures. Not all are complex, but when one is, it will be nice to have a code to use that identifies that."

When your ophthalmologist uses balloon dilation during a nasolacrimal duct probing, you'll finally have a code to pinpoint this service: 68816 (Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation).

"Our physicians are always asking about the 68811/68815 and balloon insertion, so I am curious to see if the 68816 will be helpful," Stillman says. "On this one, only time will tell."

Bonus: Experts expect that you'll be able to report 68816 bilaterally like you can with 68811 (Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia) and 68815 (Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent).

Say goodbye to temporary code 0065T (Ocular photoscreening with interpretation and report, bilateral). January's changes delete this code and replace it with 99174, which has the same descriptor. This is a positive first step toward reimbursement for this service from major carriers, experts say.

Other changes to note:

• Begin using 67229 (Treatment of extensive or pro-gressive retinopathy, one or more sessions; preterm infant [less than 37 weeks gestation at birth], performed from birth up to 1 year of age [e.g., retinopathy of pre-maturity], photocoagulation or cryotherapy) when your ophthalmologist treats retinopathy in preterm infants.

• CPT 2008 changes the descriptor for 67227 (Destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions, cryotherapy, diathermy) and 67228 (Treatment of extensive or progressive retinopathy, one or more sessions; [e.g., diabetic retinopathy], photocoagulation).

• Add four new Category III codes to your arsenal:

• +0173T -- Monitoring of intraocular pressure during vitrectomy surgery (list separately in addition to code for primary procedure)

• 0176T -- Transluminal dilation of aqueous outflow canal; without retention of device or stent

• 0177T -- Transluminal dilation of aqueous outflow canal; with retention of device or stent

• 0181T -- Corneal hysteresis determination, by air impulse stimulation, bilateral, with interpretation and report.

If you participate in the Physician Quality Reporting Initiative (PQRI) program, the eight new Category II codes this year should look familiar. CPT 2008 lists the measures, which you've been able to use since July 1, 2007:

• 1055F -- Visual functional status assessed (EC)

• 2019F -- Dilated macular exam performed, including documentation of the presence or absence of macular thickening or hemorrhage and the level of macular degeneration severity (EC)

• 2020F -- Dilated fundus evaluation performed within six months prior to cataract surgery (EC)

• 2021F -- Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy (EC)

• 2027F -- Optic nerve head evaluation performed (EC)

• 3073F -- Pre-surgical (cataract) axial length, corneal power measurement and method of intraocular lens power calculation documented within six months prior to surgery (EC)

• 4007F -- Age-Related Eye Disease Study (AREDS) formulation prescribed or recommended (EC)

• 5010F -- Findings of dilated macular or fundus exam communicated to the physician managing the diabetes care (EC).

"I believe the bonus for reporting PQRI codes this year was a precursor to standard reporting of the Category II code," says Rita Knapp, CPC, chief compliance officer and senior billing specialist at Abrams Eyecare Associates in Indianapolis. This will affect those doctors who chose not to participate in PQRI in 2007, "as the reporting docs are now familiar with the use of these codes," she adds.