Ophthalmology and Optometry Coding Alert

Answer 1: D. This year CPT deleted 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) and replaced it with three new vitrectomy codes (67041-67043). For a vitrectomy with subretinal membrane removal, you should report 67043, Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (e.g., choroidal neovascularization), includes, if performed, intraocular tamponade (i.e., air, gas or silicone oil) and laser photocoagulation.

Remember: Although the ophthalmologist used photocoagulation and intraocular tamponade, you cannot separately report these services. The new code descriptors specify that they include photocoagulation and intraocular tamponade.

Answer 2: C. CPT 2008 added 67113, Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens. You should use this code for complex retinal detachment repairs that involve a vitrectomy and neovascular membrane removal.

Codes 67101 (Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid) and 67107 (Repair of retinal detachment; scleral buckling [such as lamellar scleral dissection, imbrication or encircling procedure], with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid) represent other types of retinal detachment repairs.

Answer 3: C. When your ophthalmologist performs ocular photoscreening this year, you'll report 99174, Ocular photoscreening with interpretation and report, bilateral.

Prior to Jan. 1, you would have reported 0065T. This year CPT replaced that Category III code with Category I code 99174, which carries the same descriptor.

Answer 4: D. CPT 2008 introduced three new telephone service codes:

Although reporting 99442 might seem like the right choice because the ophthalmologist spent 17 minutes on the phone discussing the patient's care, the code descriptors for these codes specify that you cannot report 99441-99443 within seven days of an E/M service. Therefore, you cannot bill for this telephone call.

Pointer: You can consider the telephone conversation between a physician and patient as a factor when determining a service level for any follow-up related E/M service -- provided that the physician's documentation showed how the telephone conversation affected the key components of history, exam and medical decision-making for the future E/M service.

Answer 5: C. For the medical team conference that the physician assistant (a nonphysician practitioner) took part in, you should report 99366, Medical team conference with interdisciplinary team of healthcare professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified healthcare professional. CPT 2008 replaced old team conference codes 99361 and 99362 with 99366-99368.

The details: The main difference between 99366-99368 and the prior codes is that you can use two of the new codes, including 99366, for nonphysician practitioners. All three of the new code descriptors specify a minimum service time of 30 minutes or more, but 99366 also stipulates that the patient and/or family must be present during the conference.

-- Answers reviewed by Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.