Article

Coding

Coding update for 2018

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.

ICD-10

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
Table 1. Abbreviated list of new 2018 eye code changes for ICD-10-CM
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.

CPT codes

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.

Table 2. Abbreviated list of 2018 CPT code changes
CPT Code Status Short Descriptor Comment
15730 New Midface flap w/ preservation of vascular pedicle
15733 New Muscle, myocutaneous, or fasciocutaneous flap
15732 Deleted Muscle, myocutaneous, or fasciocutaneous flap; head and neck
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

Conclusion

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