New CPT codes and an ICD-10 update.
New codes for CPT are out and became effective on Jan. 1, 2018. Also, the “2018” ICD-10 code updates happened on Oct. 1, 2017 — codes actually are released in October of the preceding year. Some codes were deleted and can’t be used anymore, so we’ll cover both situations.
Having the most current code list is important so that your office’s claims are promptly and correctly paid. Someone in the office should obtain an updated code book for ICD-10 and CPT for 2018 — this will likely be in your billing office, but you need to know where to access it.
For ICD-10, the changes aren’t as significant as last year when we saw a lot of updates to laterality for AMD, open-angle glaucoma, and diabetic eye disease.
The most significant change in eye care this year is more specificity in the Myopic Degeneration and Low Vision/Blindness codes. Myopic degeneration codes are more common in everyday clinical use. The low vision/blindness codes are not as commonly used, but the list of changes is long because of laterality.
Table 1 contains an abbreviated list of the changes; the “ending dash” means more specificity (here it’s generally to include the sides — OD, OS, or OU and, in the case of low vision and blindness, how severe the loss). It can seem quite confusing to choose a code in the Low Vision/Blindness area, but if you focus first on which eye has low vision and/or is blind, then it becomes much easier. Here are some examples:
- H54.413A. Blindness OD Category 3, normal VA OS
- H54.52A1. Low vision OS, Category 1-2, normal VA OD
|ICD-10-CM Code||Short descriptor|
|H44.2A-||Degenerative Myopia w/ choroidal neovascularization|
|H44.2B-||Degenerative Myopia w/ macular hole|
|H44.2C-||Degenerative Myopia w/ retinal detachment|
|H44.2D-||Degenerative Myopia w/ foveoschisis|
|H44.2E-||Degenerative Myopia w/ other maculopathy|
|H54.0-||Blindness in both eyes but different categories of blindness|
|H54-1-||Blindness one eye, Low Vision other eye|
|H54.2-||Low Vision both eyes but different categories of Low VA|
|H54.4-||Blindness one eye, Normal vision other eye|
|H54.5-||Low Vision one eye, Normal vision other eye|
In case you wondered if I forgot the H54.3 area, it doesn’t exist at all (yet). This may have been intentionally planned to allow for code changes in the future.
Table 2 is a partial list of the 2018 CPT code changes that I think impact the average ophthalmic tech. CPT category I code changes went into effect on Jan. 1, 2018, but Category III codes (those ending in “T”) can go into effect in either January or July.
|CPT Code||Status||Short Descriptor||Comment|
|15730||New||Midface flap w/ preservation of vascular pedicle|
|15733||New||Muscle, myocutaneous, or fasciocutaneous flap|
|31253||New||Nasal/sinus endoscopy with ethmoidectomy; total, including frontal sinus exploration w/ removal of tissue from frontal sinus|
|31257||New||Nasal/sinus endoscopy with ethmoidectomy; total, including sphenoidotomy|
|31259||New||Nasal/sinus endoscopy with ethmoidectomy; total, including sphenoidotomy, with removal of tissue from sphenoid sinus|
|31254||Revised||Nasal/sinus endoscopy with ethmoidectomy; partial|
|31255||Revised||Nasal/sinus endoscopy with ethmoidectomy; total|
|95930||Revised||Visual evoked potential, checkerboard or flash, CNS, except glaucoma, w/ interpretation and report||If this is for glaucoma, use 0464T|
|0474T||New||Insertion of anterior segment drainage device w/ creation of extraocular reservoir, internal, to supraciliary space||CyPass Stent|
|0449T||New||Insertion of anterior segment drainage device w/o extraocular reservoir, internal, to subconjunctival space||XEN Gel Stent|
If your office mistakenly uses a deleted or less-specific code, your office should get a claims denial for using the “invalid code.” Your billers might come to you and ask for a code that matches the chart. You can help them fix the claim by suggesting a more updated and specific code. Then, the doctor can confirm it.
Keeping abreast of coding changes is important both from a documentation perspective as well as a claims and reimbursement one. Be sure your office has at least one copy of the updated code books each year.
As always, “good coding to you.” OP