Ophthalmology and Optometry Coding Alert

Question: What is the new Category II section in CPT, and how do we use it?
      
Florida Subscriber

Answer: CPT 2004 introduces the Category II code section, but these codes probably won't add anything to your reimbursement.
 
The Category II codes track performance measurements. The AMA intends to use these codes to collect data about quality of care.
 
Using Category II codes is optional, and you may not substitute them for the regular Category I
CPT codes.  
 
Suppose you're trying to track a patient's hypertension after a diagnosis of hypertensive retinopathy, and you don't have the patient's electronic health record.
 
Reporting the new blood pressure measurement Category II code, 0001F, will allow you to do this through your claims data or practice management software rather than through chart reviews.
 
If you see the patient to help manage the hypertension, make sure you report the counseling Category I code, such as 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes), linked to ICD-9 code that describes the type of hypertension.  Remember that the counseling codes have "separate procedure" in their language and should not be billed on the same day as another E/M service or eye code.
 
The AMA will publish new Category II codes twice a year: Jan. 1 and July 1. For the most current listing, visit www.ama-assn.org/go/cpt.