Ophthalmology and Optometry Coding Alert

Look for both new, revised codes effective Jan. 1.

The new year is quickly approaching, and that also means an influx of new CPT® codes to your practice. Among the 394 code changes on the horizon for 2020 are quite a few that will impact eye care practices. With 248 total new codes, 75 revisions, and 71 deletions on deck for 2020, it’s a good time to review the codes that will be most relevant to your eye care practice and prepare now. Read on for the highlights.

Check Out New Cataract Codes

You’ll find a few important adjustments to the cataract codes that will go into effect Jan. 1.

Revisions: Cataract removal code 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)) and complex removal code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage) will each have “without endoscopic cyclophotocoagulation” added to the ends of their descriptors.

New codes: These changes make room for the addition of two new cataract removal procedure codes that include endoscopic cyclophotocoagulation:

• 66987 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation)
• 66988 (… with endoscopic cyclophotocoagulation)

Here’s what that means: Endoscopic cyclophotocoagulation allows the ophthalmologist to view the procedural area through an endoscopic camera so the laser beam can be placed more precisely to treat the ciliary body of the eye and decrease the amount of pressure. It’s often used to treat cataract patients who also suffer from glaucoma and allows alleviation for both conditions. The code changes allow you to easily differentiate between cataract removal procedures that do and don’t have endoscopic cyclophotocoagulation included in them.

Prep for Ophthalmoscopy Coding Changes

CPT^® will delete ophthalmoscopy codes 92225-92226 (Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report…), and will instead debut the following two codes in their place:

• 92201 (Ophthalmoscopy, extended; with retinal drawing and scleral sepression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral)
• 92202 (… with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral)

The new codes have more extensive descriptors as compared to the existing ones, noting a wider variety of potential conditions that the services treat, and also illuminating the fact that the same codes apply whether the physician is treating one eye or both. Therefore, the descriptors make it clear that there is no need to report two units of the code or to append modifier 50 (Bilateral procedure) if you treat both eyes.

Strike 99444 From Your Code List

You’ll find that any digital or e-visit E/M services will be coded quite differently than in the past, with CPT^® now deleting 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

In its place, CPT^® will introduce 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes) on January 1.

Like its predecessor, 99421 has some significant restrictions, which stipulate that the service has to be:

• Provided to an established patient (or guardian),
• Provided by a physician or other qualified health care professional (QHP), and
• Unrelated to an E/M service provided within the previous seven days.

This means that any online digital E/M service that results from a previous, or that results in a subsequent, E/M visit is not separately reported, and the online E/M service is incorporated into the related E/M visit.

In addition, CPT^® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

Time Changes Hit 98970 Series

You’ll also say goodbye to code 98969 (Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network) effective January 1.

In its place, you’ll be able to use three new time-based codes to report the same, asynchronous online services to your patients:

• 98970 (Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 98971 (… 11-20 minutes)
• 98972 (… 21 or more minutes).

“With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said AMA President Patrice A. Harris, MD in a statement about the new changes. “The new CPT^® codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”