Ophthalmology and Optometry Coding Alert

Tip: Review CMS' Web site to update charge forms

CMS has scrapped the 90-day grace period you once had for implementing new ICD-9 and HCPCS codes, according to two Feb. 6 CMS transmittals (Nos. 89 and 95). The new rule, however, shouldn't cause your ophthalmology practice many problems, coding experts say.

The grace period allowed providers "to ascertain the new codes and learn about the discontinued codes," CMS says. But HIPAA's "transaction and code set rule" mandates that physicians and practices report codes that are valid at the time the physician rendered the service.

Result: You will have to begin using new and revised ICD-9 codes when CMS makes them effective on Oct. 1, 2004. You will not have 90 days to continue using the old codes. For CPT codes and HCPCS Level II codes, the new grace-period ruling becomes effective on Jan. 1, 2005.

Get a Grip on the New Rule

Follow these two examples for coding under CMS' new rule.

Example #1: On Oct. 1, 2003, HHS introduced three new ICD-9 diagnosis codes to expand V58.6 (Long-term [current] drug use). Ophthalmologists can now use V58.63 (Long-term [current] use of antiplatelets/antithrombotics), V58.64 (Long-term [current] use of non-steroidal anti-inflammatories) and V58.65 (Long-term [current] use of steroids) to track the ocular side effects of those drugs.    

Previously, ophthalmologists would have used V58.69 (Long-term [current] use of other medications) to report the drug use. Under the grace period, you could have reported V58.69 until Dec. 31, 2003. Without the grace period, however, you should use the more specific codes on Oct. 1.

Example #2: Remember that CMS' grace-period elimination also applies to new CPT and HCPCS codes. For instance, on Jan. 1, 2004, CPT introduced new code 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) to replace 67999 (Unlisted procedure, eyelids) and 67911 (Correction of lid retraction), which the Academy of Otolaryngology-Head and Neck Surgery formerly recommended. You had until March 31, 2004, to begin reporting 67912. But next year you will have to begin assigning new codes on Jan. 1, 2005, the day they take effect.

Spread the Word About New Codes

What to do: You shouldn't encounter many coding difficulties or denials without a grace period as long as you update your encounter forms by the ICD-9 and HCPCS deadlines, says Melanie Witt, RN, CPC, MA, an independent coding consulting in Fredericksburg, Va.

The Federal Register usually publishes new codes well in advance of their release, so you should have enough time to make the changes, she adds.

"You need to let your staff know that there is a set of new codes," Witt says.

You can even handwrite the new codes in the encounter form's "Other" blank, she says.

Download: After the Federal Register publishes the codes, CMS posts them on its Web site. New, revised and discontinued ICD-9 codes should appear online at http://www.cms.hhs.gov/medlearn/icd9code.asp sometime after May 1, 2004. CMS will publish the updated CPT and HCPCS codes at http://www.cms.hhs.gov/providers/pufdownload/anhcpcdl.asp at the end of October 2004.
 
Beware: Medicare will be ready to accept these codes the day they become effective, but some private carriers may not be. If a carrier denies a correct code, talk to the provider representative and alert him to the new code.