Ophthalmology and Optometry Coding Alert

Hint: Don’t forget new Category III codes.

Eye care practices are ringing in the new year with a recently debuted retinal imaging code, as well as updates to other eye care codes. To ensure that you report these services properly in 2021, we’ve got three expert tips that will help you steer your eye coding in the right direction.

Tip 1: Remember That 92227 Is Now a Parent Code

The 2021 edition of CPT^® includes new code 92229 (Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral). As a result of the new code debut, the code book also includes changes to the following existing codes:

• 92227 (Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral)
• 92228 (…with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral)

The change makes 92227 a parent code, which it wasn’t in the past, said Michael Repka, MD, MBA, during an ophthalmology discussion at the American Medical Association’s November CPT^® Symposium. In addition, he noted 92228 is now a child code to 92227, specifying “use by physicians/qualified healthcare professionals to interpret the photos and prepare a report.”

In addition, 92229 is a child code to 92227 as well, describing remote retinal imaging, which has been approved by the FDA for diabetes mellitus retinopathy using augmented intelligence, he said. The new codes reflect the expansion of technological options in the ophthalmology field, Repka said. “Other retinal vascular conditions may be added in the future, such as retinopathy or prematurity,” he noted.

Tip 2: You Can Now Report 76513 for Unilateral or Bilateral Scans

Ophthalmic ultrasounds allow eye care physicians to diagnose complex conditions, and these are typically performed using B-scan, A-scan, or ultrasound technology. Although the 2021 edition of CPT^® didn’t debut any new codes in this category, you will find revisions to the descriptor for 76513 (Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral). The bolded section of the descriptor shows the new verbiage.

After investigating the standard use of this code, it was determined that the service is typically being performed bilaterally, which prompted the revision, Repka noted. “Therefore, code 76513 can now be reported in one or both eyes,” he said.

Tip 3: Look to Category III Code for Remote Retinal OCT

In some cases, ophthalmologists will diagnose patients with degenerative diseases, such as wet age-related macular degeneration, and will plan to monitor the patients for disease progression. When performed via remote optical coherence tomography (OCT), it has been challenging to find a way to bill for the service — but not anymore. CPT^® 2021 includes three Category III codes that you can use to describe these services, as follows:

• 0604T (Optical coherence tomography (OCT) of retina, remote, patient-initiated image capture and transmission to a remote surveillance center, unilateral or bilateral; initial device provision, set-up and patient education on use of equipment)
• 0605T (…remote surveillance center technical support, data analyses and reports, with a minimum of 8 daily recordings, each 30 days)
• 0606T (…review, interpretation and report by the prescribing physician or other qualified health care professional of remote surveillance center data analyses, each 30 days)

Although you won’t be able to collect reimbursement for these codes yet, using them will allow payers to see how you’re utilizing these services and could open the door for payment down the road. “Category III codes provide the means for data collection, analysis of clinical efficacy, emerging technologies, services, and procedures,” Repka said.