Ophthalmology and Optometry Coding Alert

You’ll also see changes to angiography reporting.

Although it’s still October, you should already be prepping for the New Year, because it could change the way you report fluorescein angiography. This change and others will be among the most impactful adjustments to CPT^® for ophthalmology practices effective Jan. 1.

Caution: These updates are based on the preliminary list of code adjustments, and changes may occur before the code set is final. Keep checking back in to Ophthalmology Coding Alert for news about the final codes and details on proper use of your updated options.

Look for Change to ‘1 or More’ Retinal Repair

Currently, when you repair a retinal detachment, you bill 67101 once, regardless of how many sessions you perform. Starting in 2017, however, CPT^® has removed the “1 or more sessions” designation from 67101. Because 67101 is also the parent code of 67105, this change will impact both 67101 and 67105, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.

Following is the breakdown of how these two codes will change starting Jan. 1, with the changes highlighted using strikethroughs to identify verbiage that will be deleted in 2017 and underlining to show text that’s new effective Jan. 1:

Fingers crossed: Ideally, this change could mean that CMS might now allow practices to report multiple units of the code for more than one session, but no coverage decisions have been issued at this point explaining the impetus behind removing “1 or more sessions” from these code descriptors.

Angiography Codes Now Bilateral

CPT^® 2017 also updates two angiography codes to explain that the codes apply for both unilateral and bilateral procedures, as follows:

This change could lead to a cut in reimbursement for ophthalmologists, since you can currently append modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) to 92235 and 92240 when billing bilaterally, allowing you to collect higher payments for bilateral services. Once the code changes go through as indicated above, it’s likely that you’ll only report one unit of 92235 or 92240 even if you perform the angiography service on both eyes.

Keep in mind: It is unclear whether CMS and other payers will adjust the RVUs for these codes due to the changes, but keep an eye on Ophthalmology Coding Alert for more on these codes as payers release information about how to report them going forward.