New codes and revisions
A few changes could impact how you file for services in 2016.
BY PAUL M. LARSON, MBA, MMSC, COMT, COE, CPC, CPMA
New and revised CPT and Health Care Procedure Coding System (HCPCS) codes are here, and knowledge of these codes is key to proper reimbursement. This is especially true for revised codes — when the code descriptor changes, you could incorrectly miss revenue or file for services inappropriately.
The following codes are required for dates of service after Jan. 1, 2016.
The two new 2016 codes are as follows:
• CPT 65785. This code replaces Category III code 0099T, which has been deleted. The code descriptor remained unchanged: “Implantation of intrastromal corneal ring segments.”
• 0402T. This code was released on July 1, 2015 (use began on Jan. 1, 2016). The code descriptor is “Collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed).” CPT also notes not to report 0402T in conjunction with CPT codes 65435 (corneal epithelial removal), 69990 (use of operating microscope), or 76514 (corneal pachymetry via ultrasound).
The revised code list is far more extensive. First, CPT 67112 has been deleted, as has Category III code 0099T (see above). Since CPT 67112 was rarely used, this change is unlikely to affect most surgeons. Instead, choose the alternate code that fits.
Also, the “one or more sessions” language was removed from the following three codes, which generally means that unplanned retreatments in the global period may now be billable:
• 65855. Trabeculoplasty by laser surgery
• 67227. Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), cryotherapy, diathermy
• 67228. Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation.
Some codes have revised descriptions that do not substantively change the definition (listed with
removed language as strike-through and new language underlined.
• 67101. Repair of retinal detachment, 1 or more sessions; cryotherapy or diathermy
with or without including drainage of subretinal fluid when performed
• 67105. Photocoagulation
with or without including drainage of subretinal fluid, when performed
• 67107. Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure),
with or without including, when performed, implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid
• 67108. Repair of retinal detachment; with vitrectomy, any method,
with or without including, when performed, air or gas tamponade, focal endolaser photocoagulation … and/or removal of lens by same technique
• 67113. Repair of complex retinal detachment … with vitrectomy and membrane peeling, including,
may include when performed, air, gas, or silicone oil …
• 99174. Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral; with remote analysis and report
• 0308T. Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis.
Lastly, some newer HCPCS drug codes are significant:
• C9447. Injection, phenylephrine and ketorolac, 4 ml vial. This code currently only for the proprietary intraoperative-only combination drug Omidria (Omeros). The code has been available since January 1, 2015, but many of us are only now encountering it.
• C9450. Injection, fluocinolone acetonide intravitreal implant, 0.01 mg. Currently, this code only applies to Iluvien (Alimera Sciences). It requires 19 units on the claim for proper reimbursement since the device has 0.19 mg of the drug. The code was effective as of April 1, 2015.
• Q9977. Compounded drug, not otherwise classified (NOC). Effective July 1, 2015, this code is generally for use on claims in place of codes that currently require J3490 (unclassified drug) and J3590 (unclassified biologics) in eye care. Check for payer guidance on this code as this won’t work for all payers or Medicare contractors.
While Medicare used the new codes and code descriptor revisions immediately on the effective date, some private payers may still require the old codes for a variable period of time. So, be sure and check with those payers.
As always, “good coding” to you! OP
Mr. Larson is a senior consultant at Corcoran Consulting Group. He specializes in coding and reimbursement. Mr. Larson is based in Atlanta.