Ophthalmology and Optometry Coding Alert

Be prepared for a host of new telemedicine codes.

It won’t take a lot for you to stay abreast of the 2025 CPT^® changes to the ophthalmology codes. But don’t get too excited. There are numerous telemedicine code additions and deletions coming that you will have to learn prior to their effective release date of Jan. 1, 2025.

Don’t worry, though. We’ve got you covered. Here are all the highlights you need to know.

Know These Computerized Ophthalmic Diagnostic Imaging Changes

First, the ophthalmology codes. CPT^® 2025 has revised the descriptors to the computerized ophthalmic diagnostic imaging codes, deleting the word “scanning” from the parent code. The 2025 code set will also include a new code for retina imaging including optical coherence tomography (OCT); in all, the four codes changes are:

• 92132 (Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), anterior segment, with interpretation and report, unilateral or bilateral)
• 92133 (Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve)
• 92134 (… retina)
• 92137 (… retina, including OCT angiography)

Instructions for new code 92137 tell you not to report the code with 92133 or 92134 at the same patient encounter, and to report the code separately when performed at the same encounter as 92235 (Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral), 92240 (Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral), and 92242 (Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral).

Know This New Iris Repair Code

CPT^® 2025 also introduces another new code in the Eye and Ocular Adnexa Surgery codes: 66683 (Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed). The code comes with two extensive instructions:

Use the code in conjunction with intraocular lens respositioning code 66825; lens removal codes 66830, 66840, 66850, 66852, 66920, 66930, and 66940; and intraocular lens procedures 66982, 66983,66984, 66985, 66986, 66987, 66988, 66989, and 66991, “for lens or intraocular lens surgery[ies] performed concurrently.”

Do not report the code with anterior chamber paracentesis codes 65800, 65810, and 65815; anterior segment adhesion severing codes 65865, 65870, and 65875; anterior chamber injection codes 66020 and 66030; stab incision iridotomy codes 66500 and 66505; iridectomy codes 66600, 66625, 66630, and 66635; iris repair codes 66680 and 66682; iris cyst or lesion destruction code 66770; retrobulbar and Tenon’s capsule injection codes 67500 and 67515; and microsurgical technique with operating microscope code 69990, “for the same eye, same surgeon, or same operative session.”

Dial-In These New Telemedicine Codes

As anticipated, CPT^® has massively overhauled the telemedicine service codes, and you’ll have 17 new codes to choose from in the New Year. The new codes will replace the old telephone evaluation and management (E/M) codes 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient …), which will be deleted on Jan. 1, 2025, the date the new codes take effect.

Audio/video: The new codes include eight new synchronous audio/video E/M codes: 98000-98003 (Synchronous audio-video visit for the evaluation and management of a new patient …) for new patients and 98004-98007 (Synchronous audio-video visit for the evaluation and management of an established patient …) for established patients.

You will determine the appropriate service level for the codes in the same way you do for the office/outpatient E/M service codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …), either by determining the level of medical decision making (MDM) as straightforward, low, moderate, or high per the CPT^® E/M guidelines, or by calculating the total physician time for the service on the date of the encounter. Both the MDM level and total service times for 98000-98007 parallel the levels for 99202-99215.

Audio-only: Additionally, you will have eight new synchronous audio-only E/M at your disposal next year. For new patients, you will choose from 98008-98011 (Synchronous audio-only visit for the evaluation and management of a new patient …), while you’ll use 98012-98015 (Synchronous audio-only visit for the evaluation and management of an established patient …) for established patient audio-only E/M services.

MDM levels for these codes are also the same as the office/ outpatient and synchronous audio/video E/M codes — straightforward, low, moderate, or high — as are the levels of physician time spent

Note These Other Telemedicine Time Guidelines

For synchronous audio-only E/Ms lasting for 5-10 minutes, you will report another new code — 98016 (Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient … 5-10 minutes of medical discussion) — if appropriate. This means, per the code’s descriptor, the service must not have originated “from a related evaluation and management service provided within the previous 7 days,” nor led “to an evaluation and management service or procedure within the next 24 hours or soonest available appointment.” The code’s descriptor also stipulates that the code can only be used for established patients.

For the highest level synchronous audio-video and audio only E/M services (98003, 98007, 98011, and 98015), you’ll be able to use existing prolonged service add-on code +99417 (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)) for services that go beyond the codes’ time parameters. You’ll use one unit of the code to document each increment of 15 minutes beyond the 60 minute upper threshold of new patient codes 98003 and 98011, and beyond the 40 minute upper threshold of established patient codes 98004 and 98015.