Ophthalmology and Optometry Coding Alert

V codes victorious, no more seeing stars*

The new CPT codes for 2004 will include significant changes for ophthalmology practices, so be ready.
 
While updates can sometimes seem to come at a glacial pace, some carriers are unforgiving when it comes to providers updating their billing systems.
 
"As a whole, the CPT coding system works very well as a catalog of accepted medical services, tests and procedures," says Dr. Michael Yaros, a practicing ophthalmologist based in Runnemede, N.J., "but it can take time for new technology and procedures to be added to the corpus.
 
"I personally feel a more comprehensive overhaul is needed, along with an expedited method of incorporating new technology."

 The changes include five new surgery codes (65780, 65781, 65782, 67912, 68371), one new radiology code (76514), and four revisions to surgical codes (67916, 67917, 67923, 67924).
 
Also, CPT has done away with starred procedures. A star (*) beside a procedure code in previous CPT manuals denotes a relatively minor surgical procedure that can require variable amounts of preoperative and postoperative services.
 
Because the pre-op and post-op care that is required can vary, CPT did not assign the normal "package" concept to these as it did to other surgical procedure codes.
 
Instead, it marked them with a star to indicate that only the procedure itself is reported with use of the code and associated pre- and postoperative services are not included in the service as listed. 
 
Offices could code pre-op and post-op care separately as necessary on an individual basis. Not any more. In the new CPT 2004, starred procedures will be bundled into the global for all procedures.
 
"Since the starred procedure includes no post-op care, the payments are for the procedure only," Yaros says. "As long as the redefined global period lengths are both appropriate and reflect appropriate reimbursement for post-op care, I don't think it will be a problem to eliminate the stars. Most procedures did not previously have stars, anyway."

Stem Cell Technology Warrants New Procedure Codes

The new surgical codes 65780 (Ocular surface reconstruction; amniotic membrane transplantation), 65781 (... limbal stem cell allograft [e.g., cadaveric or living donor]), and 65782 (... limbal conjunctival autograft [includes obtaining graft]) reflect technological advances in the use of stem cells in the treatment of limbal epithelial cell loss.
 
The stem cells are harvested from cadaveric or living donors and used in the treatment of severely damaged corneas after inflammatory diseases.
 
"These codes are all related to new knowledge about ocular surface disease and the role of stem cells," Yaros says. "As such, they are a welcome addition. Physicians are more likely to learn about and perform new procedures when they are assured there will be fair reimbursement.
 
"In the past, physicians had to use an 'unlisted' code to report these," Yaros says. "Unlisted codes always mean headaches for billers, and require more work to get paid."
 
The surgical code 68371 (Harvesting conjunctival allograft, living donor) was also added, as was 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]).
 
"67912 represents the correction of a long-standing omission," Yaros says. "Lid weights, although uncommon, have been in use for decades. Finally there is a code that addresses the payment."
 
The new radiology code 76514 (Ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) is an addition to base code 76511 (Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification). 
 
The surgical code revisions remove the term "blepharoplasty" from the code descriptors for procedures designed to repair eyelids.
 
Codes 67916 (... excision tarsal wedge) and 67917 (... extensive [e.g., tarsal strip operations]) are additions to the base codes 67914 (Repair of ectropion; suture).
 
Codes 67923 (... excision tarsal wedge) and 67924 (... extensive [e.g., tarsal strip or capsulopalpebral fascia repairs operation]) are part of the base code 67921 (Repair of entropion; suture).
 
Note: While these changes are scheduled to take effect on Jan. 1, 2004, consult your carriers for their specific timetable for implementing these changes.
 
Carriers are given a grace period to update their software, but some of them are less than gracious about reimbursement. Some will require immediate use of the new codes, but others will not reimburse immediately when you use the new codes.