2017 Ophthalmology Code Updates: Make Room for New Angiography & Category III Codes (Article)

Category III codes — 0444T and 0445T — will eventually enter into CMS fee schedule.

You may have mastered all that CMS and the healthcare industry have thrown at you over the past year — from HIPAA audits to the end of the ICD-10 grace period — now is a good time to go over 2017 ophthalmology procedure codes so you get a firm handle on how to report the latest code updates.

Here we take a look at new 2017 CPT® codes, guidelines and updates

Change How You Report Angiography

You’ll now have to change how you report angiography as CPT® now combines the codes 92235 and 92240 into a new code 92242. This is primarily because fluorescein angiography plays a key role in ophthalmoscopic diagnosis, particularly for the diagnosis and evaluation of many retinal conditions. And since physicians who perform it want to do the IGA test later on – therefore they perform both. And since this was very common, the American Medical Association (AMA) decided to add a new code.

Look to New Category III Codes

You now have several new Category III codes to use for 2017 – including 0444T and 0445T. Although not payable - 99 percent of the time, these T codes will eventually become a Category I code and enter into CMS fee schedule. So ensure that your physicians know these codes exist and that they can use them if they are performing these procedures. 

CPT® also brings new code 0464T – even though the code is effective Jan.1, 2017, it will appear only in next year’s CPT® manual. This is an important change because thousands of eye care professionals across the US have bought VEP equipment and are using it for their glaucoma practice.

Normally, neurologists perform visual evoked potential tests and report 95930 for it. The CPT® committee introduced this new code after observing that the tests were becoming very common in eye care practices. Moreover, if the code gets used a lot, the committee has plans to convert it into a CPT® code.

Heed This: If this code is reimbursed for glaucoma and nobody pays on the T code, then it could be an issue for those who invested in the equipment. Do consider this if you are planning to buy the equipment any time soon. It probably won’t be an issue this year, but it could be in the coming years. So if you get a denial for 95930 – it could be due to the T code.

For more articles covering the latest CPT® 2017 changes affecting your ophthalmology coding and reimbursement, look to Ophthalmology Coding Alert

Posted by: George, Medical Biller, SuperCoder, United States (22-Mar-2017)
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