Beginning Jan. 1, several codes have been omitted and added.
Last issue we dealt with the updates to ICD-10 for 2019 (bit.ly/OP2019Updates ). This issue it’s CPT updates that go into effect on Jan. 1. Here are the few new code changes I suspect might be commonly considered in an eyecare practice. We already dealt with the mid-year CPT code changes in a recent article (bit.ly/OPmid-year-codes ).
Those codes that are DELETED and no longer available for use after Dec. 31 include:
- 66220 Repair of scleral staphyloma; without graft
- 92275 Electroretinography with interpretation and report
- 0190T Placement of intraocular radiation source applicator
Three of the new codes for use on Jan. 1, replace the 92275 code, listed above.
- 92273 Electroretinography (ERG), with interpretation and report; full field (ie, ffERG, flash ERG, Ganzfeld ERG)
- 92274 Electroretinography (ERG), with interpretation and report; multifocal (mfERG)
- 0509T Electroretinography (ERG) with interpretation and report, pattern (PERG)
For this section, CPT also published a new paragraph to help guide us on the code differences for ERG. It states: “Electroretinography (ERG) is used to evaluate function of the retina and optic nerve of the eye, including photoreceptors and ganglion cells. A number of techniques target different areas of the eye, including full field (flash and flicker, 92273), for a global response of photoreceptors in multiple separate locations in the retina, e.g. the macula, and pattern (0509T), for retinal ganglion cells are used. Multiple additional terms and techniques are used to describe various types of ERG. If the technique used is not specifically named in the code descriptions for 92273, 92274, 0509T, use the unlisted procedure code 92499.”
The last of the new eye codes likely to be encountered are:
- 0514T Intraoperative visual axis identification using patient fixation (List separately in addition to code for primary procedure)
Not much is known about this code for now.
Other, less likely, codes for eye care — but possible in some offices — are shown below. You’ll notice that the main differences are in the way the surgeon does these (tangential, punch, or incisional).
- 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
- 11103 Each separate/additional lesion (List separately in addition to code for primary procedure)
- (Report 11103 in conjunction with 11102, 11104, 11106, when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used.)
- 11104 Punch biopsy of skin (including simple closure, when performed); single lesion
- 11105 Each separate/additional lesion (List separately in addition to code for primary procedure)
- (Report 11105 in conjunction with 11104, 11106, when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used.)
- 11106 Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed); single lesion
- 11107 Each separate/additional lesion (List separately in addition to code for primary procedure)
- (Report 11107 in conjunction with 11106.)
Medicare payments for the new Category I codes are published and available on each Medicare Contractor’s website. The new ERG codes pay significantly less than the older, deleted code. Category III codes may or may not have coverage or payment; in this case, each Medicare Administrative Contractor (MAC) gets to make both a coverage decision and a payment decision for each of these (the ones ending in “T”) — and they can change their minds either way. In the situation where the MAC (or another payer) has determined they do not cover a code, it is normally up to you and your office to inform the patient via an ABN or financial waiver (bit.ly/ABN101 ) and it becomes the patient’s responsibility, if not a bundled service otherwise. National Correct Coding Initiative edits weren’t published at the time of this writing but are likely by the time it reaches you.
There are only a few changes for CPT 2019, but if you are doing or planning on buying equipment for electroretinography (ERG), they are quite significant. Be sure your staff and fellow technicians are aware of them. Check your EMR and practice management billing systems as well to ensure they are also updated. When a new code exists, you must use it.
As always, “good coding to you.” OP