Ophthalmology and Optometry Coding Alert

Plus: Several Cat. III codes will debut for eye care practices.

Feeling like your CPT® book could use some more love for eye care practices? Then the latest CPT^® updates should be a welcome sight -- for the second year in a row, ophthalmology and optometry practices are being treated to several new CPT^® codes to help you submit claims with more specificity.

We’ve scrutinized the list of new, revised, and deleted codes to highlight the ones most useful to eye care practices.

See the Big ERG Code Changes

You’ll find that ERG code 92275 (Electroretinography with interpretation and report) will be deleted effective Jan. 1, and CPT^® is replacing it with two codes that break down into full field and multifocal, said Gina Vanderwall, OCS, CPC, CPPM,  financial counselor with Finger Lakes Ophthalmology in Canandaigua, New York.

• 92273 — Electroretinography (ERG), with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG)
• 92274 — Electroretinography (ERG), with interpretation and report; multifocal (mfERG)

Here’s the difference: Full field electroretinography is considered the more conventional treatment, while in multifocal ERG, the physician stimulates multiple retinal areas using multiple sequences at the same time, simultaneously recording responses from several retinal regions. The physician will record which type of ERG he or she performed in the medical record, and if not, educate your practitioners that they’ll have to start doing so before Jan. 1 so you can select the right code.

Look for New Cat III Code for Visual Axis ID

You’ll see new Category III code +0514T (Intraoperative visual axis identification using patient fixation (List separately in addition to code for primary procedure) on the roster effective Jan. 1. “This is to be used on conjunction with cataract surgery (both regular and complex) and will allow for intraoperative visual axis identification,” Vanderwall said. “I will be interested to see if our cataract surgeons will be utilizing this intraoperatively.”

You’ll also find the new Category III ERG code 0509T (Electroretinography [ERG] with interpretation and report, pattern [PERG]), which indicates that the physician used pattern ERG to help diagnose and manage diseases such as diabetic edema and glaucoma.

What’s Cat. III? When a Category III code exists to describe a service or procedure, you must use that Category III code rather than an unlisted-procedure code to describe the service. Category III CPT^®  codes are temporary codes that describe emerging technology, services, and procedures. The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy. In other words,

Category III codes are preferred by insurers and policy makers: Category III codes give insurers and government policy makers a way to track the effectiveness and rate-of-use of as-yet-unproven technologies, which could affect future coverage decisions. Such data collection is not possible with unlisted-procedure codes. The designation of a Category III code is an important first step in wider adoption of new technology and the eventual creation of a Category I CPT^® code to describe the service (although this doesn’t happen in every case).

Say Hello to New E/M Codes

The new edition of CPT^® will also offer two E/M codes that apply to remote patient monitoring, as follows:

• 99453 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
• 99454 —…device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

You’ll also find a new code for “remote physiologic monitoring treatment management services:”

• 99457 — Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

The addition of the new E/M codes will be helpful for practices, Vanderwall said, particularly those that include multispecialty practitioners. It remains to be seen what type of reimbursement that CMS will assign to these new codes.

You’ll find that CPT^® plans to delete 61332 (Exploration of orbit [transcranial approach]; with biopsy) and 66220 (Repair of scleral staphyloma; without graft). These codes are not frequently used by eye care practices, so most practitioners shouldn’t be strongly affected by the deletions.