Ophthalmology and Optometry CPT Updates for 2017

Changes in Current Procedural Terminology (CPT®) are going to be effective on January 1, 2017. It will mark the introduction of the 22nd edition of CPT® code changes, which will see several additions, deletions, and modifications made to the existing list. The updates in the CPT® codes for ophthalmology and optometry practices will change the way you report fluorescein angiography and retinal repair. This makes it necessary for both ophthalmology and optometry practices to update themselves with code changes that will come into effect in the beginning of the next year.

Look out for Change to ‘1 or More’ Retinal Repair

At present, when a retinal detachment is repaired, 67101 is billed once, irrespective of how many sessions are performed. However, starting in 2017, CPT® has removed the designation for “1 or more sessions” from 67101. Because 67101 is also the parent code of 67105, the update will impact both 67101 and 67105.

Below is a breakdown of how the two codes will change starting January 1, 2017:

  • 67101: Repair of retinal detachment, including drainage of sub-retinal fluid when performed; cryotherapy.
  • 67105: Photocoagulation

The change would mean that CMS may now allow practices to report multiple code units for more than one session; however, no coverage decisions have been issued until now that explains the impetus behind removing “1 or more sessions” from the code descriptors.

Angiography Codes are “Bilateral” now

CPT® 2017 has also updated two angiography codes explaining that the codes apply for both unilateral and bilateral procedures, as follows:

  • 92235: Fluorescein angiography (includes multi-frame imaging) with interpretation and report, unilateral or bilateral.
  • 92240: Indocyanine-green angiography (includes multi-frame imaging) with interpretation and report, unilateral or bilateral.

The change can lead to a cut in reimbursement for ophthalmologists. Since, currently, modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) can be appended to 92235 and 92240 when billing bilaterally, it allows collecting higher payments for bilateral services. If the code changes go through as indicated, it is likely that you will only report one unit of 92235 or 92240 even when you perform the angiography service on both eyes.

More Changes:

Additions:

  • 0444T – Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral.
  • 0445T – Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral.
  • 0446T – Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training.

Deletions:

  • 0289T – Corneal incisions in the donor cornea created using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure)
  • 92140 – Provocative tests for glaucoma, with interpretation and report, without tonography.

Revisions:

  • 0333T – Visual evoked potential, screening of visual acuity, automated, with report.

However, it should be noted that the updates in ophthalmology and optometry CPT® codes are based on the preliminary list of code adjustments, and changes might occur before the code set is final. For insights on new, revised and deleted CPT® codes for the FY 2017, attend this Webinar by expert speaker Jeffrey Restuccio, CPC, CPC-H, MBA, who is a certified coding instructor specializing in Eye-care coding, billing, and documentation. You will also learn about the rules for receiving payments from patients directly and tips on how to work with Medicare as-well-as private insurance companies.

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