Ophthalmology and Optometry Coding Alert

Don’t miss these new Category III codes.

Now that the calendar has turned to the New Year, it’s a good time to go over your 2017 CPT^® book with a fine-toothed comb so you can get a firm handle on how to report the latest code updates. For a quick primer, we’ve got the scoop from Jeffrey Restuccio, CPC, COC, MBA, consultant with Ritecode and the EyeCodingForum, who shared his 2017 coding and billing tips during the Audioeducator.com conference, “New 2017 CPT^® Codes, Guidelines and More for Ophthalmology and Optometry.”

Check This Angiography Adjustment

One change for 2017 involves angiography coding, Restuccio said. CPT^® now combines codes 92235 (Fluoroscein angiography…) and 92240 (Indocyanine-green angiography…) into new code 92242 (Fluorescein angiography and indocyanine-green angiography [includes multiframe imaging] performed at the same patient encounter with interpretation and report, unilateral or bilateral).

“The reason being is that fluorescein angiography plays an important role in ophthalmoscopic diagnosis, especially for the diagnosis and evaluation of many retinal conditions,” Restuccio said. “And many doctors who perform it find they want to do the IGA test after, so they perform both, and that was actually very common, so the AMA decided to add a new code for that.”

CPT^® Brings on Category III Codes

CPT^® also debuted several Category III codes for 2017, including 0444T (Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral) and 0445T (Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral).

“If you’re involved in research, if you’re a teaching hospital, you may be working with this new technology, so you’d really need to report these,” Restuccio said. “Ninety-nine percent of the time, these are not payable. In my career, and it’s well over 20 or 25 years, I’ve actually seen one time an LCD that actually paid on a T code many years ago. It’s not very common, but I have seen it. If you were performing these new technologies — and some aren’t new, they’re now quite common — the T code will eventually become a Category I code and enter into the Medicare Fee Schedule, and insurers will start paying on it.” Make sure your physicians are aware that the T codes exist and that they plan to use them if you’re performing these procedures.

You’ll also find new code 0464T (Visual evoked potential, testing for glaucoma, with interpretation and report) to use effective Jan. 1, 2017, even though it won’t appear in the CPT^® manual until 2018. “I know for a fact that hundreds, if not thousands, of eye care professionals around the country have purchased VEP equipment and are using it for their glaucoma practice, and from the ones I’ve spoken to, it pays very well,” Restuccio says.

Visual evoked potential tests have typically been performed by neurologists who report 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash) for it, but many eye care professionals have purchased the equipment to use it for glaucoma testing, Restuccio said. Once the CPT^® committee saw how common the tests were becoming in eye care practices, they established this new Category III code to reflect that.

“If it gets used a lot, it will get converted to a CPT^® code. The problem, of course, is if this current code is being paid for glaucoma and nobody pays on the T code, then for those who invested in the equipment, that could be an issue. If you’re thinking of investing anytime soon, think about it. It probably won’t be a problem in 2017, but it could be. If you get a denial for 95930, that could be the reason, because of the new T code.”

CPT^® also includes code 0333T (Visual evoked potential, screening of visual acuity, automated), so if your practice performs this test instead, report this as your Category III code.

Look for 99358 Payment

Medicare will provide separate payment for the following two non-face-to-face codes in 2017, Restuccio said:

• 99358,  Prolonged evaluation and management service before and/or after direct patient care; first hour
• +99359, … each additional 30 minutes (List separately in addition to code for prolonged service).

In 2016, the status for these codes was “B,” meaning bundled into payment for other services. This year, Medicare is expected to pay about $113 for 99358 and $54 for 99359, Restuccio said. “Keep in mind that the CPT^® guidelines differ from the Medicare guidelines,” he advised. “CPT^® allows reporting the codes above with different dates of service, but Medicare does not. Sometimes, Medicare disagrees with CPT^® rules or guidelines, and in that situation, Medicare always trumps CPT^®.