Optometry Coding & Billing Alert
No More Amazing Grace Period To Use New Codes
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Starting Jan. 1, you'll have to start reporting the new codes immediately CMS has scrapped the 90-day grace period you once had for implementing new HCPCS and CPT codes - which means you had better be ready to start using them next month if you want your claims paid.
The grace period allowed providers "to ascertain the new codes and learn about the discontinued codes," CMS says. But HIPAA mandates that physicians and practices report codes that are valid at the time the physician rendered the service.
The new grace-period rule kicks in when the 2005 CPT and HCPCS codes become effective on Jan. 1, warns Krystin Keller, billing manager at Five Points Eye Care Center in Athens, Ga. You should already be using the new and revised ICD-9 codes for 2005, which became effective on Oct. 1 of this year, she says.
What to look for: The biggest changes affecting optometrists in 2005 are to the ophthalmic ultrasound codes. CPT is revising the code descriptors for 76511 and 76512 in 2005 (changes in bold print):
CPT is also introducing a new scan code in 2005: 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter).
The 2005 edition of CPT Changes: An Insider's View explains the changes: "The ophthalmic ultrasound codes have been revised to distinguish unique services by separating out B-scan probe (76512) from diagnostic quantitative A-scan (76511), to reflect the differences in difficulty and time required to perform this procedure."
Code 76511 describes the quantitative diagnostic A-scan done to manage intraocular tumors. Code 76512, the non-quantitative A-scan, "is built into some of the B-scan instrumentation, and is not related to the diagnostic A-scan," CPT Changes says. "Code 76510 has been added to describe performance of both a B-scan and quantitative A-scan performed during the same patient-physician encounter."
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No More Amazing Grace Period To Use New Codes
Starting Jan. 1, you'll have to start reporting the new codes immediately CMS has scrapped [...]