Ophthalmology and Optometry Coding Alert

Although CPT 2000 contains no new codes specifically related to ophthalmology, there are two changesone new code and one revised codewith which ophthalmologists will want to be familiar. First, there is a screening code for visual acuity testing, and second, 67220 has been changed.

Screening Test of Visual Acuity

Primary-care physicians, especially pediatricians, have fought hard for this new code. Testing children's visual acuity is a time-consuming process, and pediatricians do this routinely during well-visits. Now they have a code to use: 99173. The descriptor for this code is as follows:

Screening test of visual acuity, quantitative, bilateral (The screening test used must employ graduated visual acuity stimuli that allow a quantitative estimate of visual acuity (e.g., Snellen chart). Other identifiable services unrelated to this screening test provided at the same time may be reported separately (e.g. preventive medicine services). When acuity is measured as part of a general ophthalmological service or of an E/M service of the eye, it is a diagnostic examination and not a screening test.)

So what does this code mean to ophthalmologists? At first reading, ophthalmologists might believe that they would not use it at all. First, visual acuity is measured during eye exams as part of a refraction (92015), which is not a screening test but a diagnostic test used for prescribing corrective lenses. And second, Medicare pays for neither screening tests nor refractions. So are there any circumstances when an ophthalmologist might use 99173?

The answer is no. The description states that when acuity is measured as part of a general ophthalmological service or an E/M service it is not a screening test. Visual acuity testing is part of the billing for those services and not separately billable, says Michael Repka, MD, a pediatric ophthalmologist who is the American Academy of Ophthalmology's representative on the CPT advisory panel. The intent is that this will not be an ophthalmic code, says Repka.

There might be some conditions, however, under which an ophthalmologist would use the 99173, says Repka. I suppose you might do visual fields and a visual acuity screen, or a sensorimotor exam and a visual acuity screen, he says. But to charge for the screen, you wouldn't be able to do anything elseno eye code for an exam, no E/M services code.

Addition of Ocular Dynamic Phototherapy
to 67220

67220, used predominantly by retinologists in the treatment of macular degeneration, is for destruction of a localized lesion of the choroid. In CPT 2000, one type of treatment has been added as an example of a methodology to which the code applies. The full descriptor now reads: Destruction of localized lesion of choroid (e.g., choroidal neovascularization), one or more session, photocoagulation (e.g. laser, ocular photodynamic therapy).

Ocular photodynamic phototherapy is a new procedure, still in trials, that uses verteporfin (Visudyne). The medication is injected into a vein in the hand, explains Paula Lander, insurance and coding manager for Taylor and Winslow, retinologists in Dallas, TX. The medication accumulates in the choroidal neovascularization. Then, laser shined into the eye activates the verteporfin, stopping the blood vessels from growing, at least temporarily. Trials are currently ongoing in various retina practices around the country, including in the office where Lander works.

Technically, the code revision is not necessary to bill ocular photodynamic phototherapy, says Lander. Many practices have been billing for this already, using 67220, she says. Now that there is a reference to it in the code, however, retinologists may feel more comfortable billingand usingthis new technique.

There are no new additions to ICD-9 for 2000, so there are no new diagnosis codes for ophthalmology.