Coding Changes in 2008

Now that the dust has settled on the Medicare Physician Fee Schedule for at least six months, it is time to familiarize you with the large number of CPT code changes that were effective on January 1, 2008.

The 2008 standard reference manuals for coding contain many new codes, revised codes, and deleted codes applicable to ophthalmic practices.

New CPT codes:

• 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
• 67041 – Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g., macular pucker)
• 67042 – Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (e.g., for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (i.e., air, gas or silicone oil)
• 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

Deleted CPT code:

• 67038 – Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping. The new code 67113 replaces the combination of 67108 and 67038.

A new code is introduced to describe laser treatment for retinopathy of prematurity (ROP).

• 67229 – Treatment of extensive or progressive retinopathy, one or more sessions; preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (e.g., retinopathy of prematurity), photocoagulation or cryotherapy

An additional new code in the lacrimal system section of CPT is:

• 68816 –Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation

Revised code: As counterpoint to the new ‘anterior segment’ code (0187T), the words ‘posterior segment’ were added to CPT code 92135 which now reads:

Scanning computerized ophthalmic diagnostic imaging, posterior segment, (e.g. scanning laser) with interpretation and report, unilateral

New Code: Previously published as a Category III code (0065T), 99174 ocular photoscreening with interpretation and report, bilateral debuts in 2008 as a Category I CPT code.

The series of codes eligible for the add-on procedure 66990, use of ophthalmic endoscope, increases in 2008. The add-on code (+) may now be appended to the following series of surgical codes: 65820, 65875, 65920, 66985, 66986, 67036, 67039, 67040, 67041, 67042, 67043, and 67112.

Released semiannually by the American Medical Association (AMA), a series of new Category III codes implemented on January 1, 2007 appear in the hardcopy CPT 2008.

They include:

• 0173T – Monitoring of intraocular pressure during vitrectomy
• 0176T – Transluminal dilation of aqueous outflow canal; without retention of device or stent
• 0177T – Transluminal dilation of aqueous outflow canal with retention of device or stent
• 0181T – Corneal hysteresis determination, by air impulse stimulation, bilateral, with interpretation and report (implemented July 1, 2007)

One revised and two new Category III codes implemented on January 1, 2008 but will not appear in the published hardcopy CPT handbook until 2009.

• 0124T (revised) – Conjunctival incision with posterior extrascleral placement of pharmacological agent (does not include supply of medication) (for suprachorodial delivery of pharmacologic agent, use 0186T)
• 0186T – Suprachoroidal delivery of pharmacologic agent (does not include supply of medication)
• 0187T – Scanning computerized ophthalmic diagnostic imaging, anterior segment with interpretation and report, unilateral

We expect additional ophthalmic Category III codes to be published by the AMA in mid-2008 describing new technology, services, and procedures. Coverage and payment for Category III codes remains at the discretion of the Medicare administrative contractor.

New ICD-9 codes appear in the 2008 manual which were effective October 2007. They are:

• 364.81 – Floppy iris syndrome
• 364.89 – Other disorders of iris and ciliary body

Ranibizumab (Lucentis) receives a unique HCPCS code effective January 1, 2008.

• J2778, ranibizumab, 0.1 mg

Because the drug is delivered in 0.5 mg single use vials, the claim form must indicate 5 units for appropriate payment amounts.

Although not reimbursed by Medicare, a new HCPCS code exists to describe the astigmatism correction function of an IOL

• V2787. Previously, the V2788 code was being used for both the presbyopia and astigmatism correcting function of an IOL.

The definitions of several modifiers underwent some tweaking in the 2008 CPT handbook, but the changes are minor and do not impact payment. The descriptions for modifiers 22, 59, and 78 are revised. The revisions provide further detail for appropriate use. In July 2007, the HCPCS modifiers GY and KX were revised. Commercial payers should now recognize the GY modifier.

These coding updates require revisions to your computer systems, superbills, and education of physicians and staff.