By Charles B. Brownlow, OD
Coding changes are coming in 2013. Here’s an update and checklist of what you and your staff will need to know.
Optometric insurance coding will undergo changes next year. To ensure that your office coding and billing processes continue to run smoothly, make a plan to get up to date on the new coding procedures and then consider how you will educate your staff. Here are tools and tips that you can use to get up to speed.
Coding and Billing Toolbox
The American Optometric Association offers resources to help you increase the efficiency of your coding and billing process.
The following medical records and coding resources are available through AOAExcel.
• Medical records and coding webinars are provided as a no-cost AOA Member-Only benefit to educate doctors and staff on medical record keeping and coding.
• AOACodingToday.com is an AOA Member-Only benefit available to AOA members at no cost (previously $349). AOACodingToday.com is a web-based resource for information related to procedure and diagnosis codes, national and local coverage rules and Medicare relative value information.
• Codes for Optometry, is available in print and searchable CD formats from the AOA Order Department. This two-volume set includes Current Procedural Terminology from the American Medical Association, and a separate volume of diagnosis codes used in eyecare, Medicare’s Correct Coding Initiative, the HCPCS codes for reporting materials in Medicare, and the Documentation Guidelines for the Evaluation and Management Services.
• Coming in 2013: An EHR & Medical Records Compliance Program.
Visit www.ExcelOD.com for integrated professional resources to improve patient quality of care, operational practice excellence and informed business decision-making.
For more information: AskTheCodingExperts@AOA.org.
Invest in Necessary Reference Material
All health care providers must be familiar with the two key references in health care; Current Procedural Terminology (CPT American Medical Association), and International Classification of Diseases, 9th Edition. The AMA CPT and ICD-9 are the ONLY coding references for diagnosis codes, visits and procedures that are accepted by Medicare and Medicaid and the only coding references required by HIPAA.
The first step in committing all doctors in your practice to accurate medical records and coding for next year is to be sure that you have the 2013 edition of CPT. To make accurate choices of procedure codes you must have the newest Current Procedural Terminology and it must be the official AMA CPT. Other publishers’ “versions” of CPT are available, but they may distort the true definitions and should not be depended upon for accuracy. In daily use in your practice and definitely during an audit, AMA’s CPT is what you need.
AMA CPT is available to AOA members at AMA members’ prices through the AOA Order Department at 1-800-262-2210.
The following is a summary of key changes in 2011, 2012 and 2013 editions of CPT:
92135—retinal imaging, “unilateral,” was deleted and replaced by three new codes, each classified “unilateral/bilateral”:
92132–Anterior segment imaging
92133–Imaging, Optic Nerve
Note: Medicare’s reimbursement for the each of the new codes is nearly identical for both eyes to previous reimbursement for 92135 for one eye! It is acceptable to bill the same, whether the test is done on one eye or both (per recent CPT Assistant AMA update). No modifier is required, since there will not be any adjustment to reimbursement, up or down.
CPT added two codes used primarily by physicians taking fundus photos of patients with systemic diabetes and sending them to a remote “reading center” to analyze the presence or progression of retinal disease.
92227—Remote imaging for the detection of retinal disease…unilateral or bilateral
Note: (Do not report 92227 in conjunction with 92002-92014, 92133, 92134, 92250, 92228 or with the evaluation and management of the single organ system, the eye, 99201-99350)
92228—Remote imaging for monitoring and management of active retinal disease…unilateral or bilateral
Note: (Do not report 92228 in conjunction with 92002-92014, 92133, 92134, 92250, 92227 or with the evaluation and management of the single organ system, the eye, 99201-99350).
CPT deleted two eyecare codes in 2012 after surveying providers and finding few, if any, physicians actually doing either of the procedures. They are 92120—Tonography, and 92130–Tonography with water provocation.
Note: Use the CPT Category 3 code, 0198T, to report ocular blood flow measurements
Another code, 92070—Fitting of contact lens for treatment of disease, including supply of lens, was deleted and replaced with two new codes, 92071—Fitting of contact lens for treatment of ocular surface disease (also used for bandage CL), and 92072—Fitting of contact lens for management of keratoconus, initial fitting.
Note: According to CPT Assistant (AMA) “report supply of lens separately with 99070 or appropriate supply code” e.g. HCPCS code
Several codes had language changes for 2013, though the numbers stayed the same. For your reference, we’ve put the new or additional wording in bold italics and have used strike through for deleted language:
• 92015, Determination of refractive state (For instrument-based ocular screening, use 99174)
• 92132, Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. For specular microscopy and endothelial cell analysis, use 92286
• 92286, Anterior segment photography imaging, with specular microscopy and endothelial cell count analysis
• Changes in definitions for 92002, 92012, 92004, 92014 include, “Interpretation and report by the physician or other qualified health care professional is an integral part of special ophthalmological services where indicated…,”and” (For distinguishing between new and established patients, see Evaluation and Management guidelines)”
Note: those guidelines are found at the front of the CPT manual
• In the section “Spectacle Services (Including Prosthesis for Aphakia)”, “When provided by the physician, fitting of spectacles is a separate service when provided by the physician and is reported as indicated by 92340-92371…Presence of the physician or other qualified health care professional is not required.”
• Ophthalmic Surgery Code Changes, 2013
Note: Some of these codes may not be common in optometric practice, and are provided in the interest of complete reporting
65805, Deleted, replaced with…
65800, Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous, and in the definition of the code…
67810, Incisional biopsy of eyelid skin including lid margin, “(for biopsy of skin of the eyelid, see 11100, 11101, 11310, 11313)”
No Changes in International Classification of Diseases for 2013 or 2014!
It is also important to note that there are no changes in ICD-9 codes for 2013, nor will there be any in 2014. The next change in diagnosis coding will be the big one, when ICD-10 becomes the “law of the land” on October 1, 2014.
In-Office Preparation for Medical Record Keeping and Coding, 2013
All doctors and key staff should read the 2013 CPT definitions for your practice’s 20-30 most commonly billed services. Clear and thorough knowledge of CPT coding for 2013 is only possible if you have the 2013 AMA CPT. The only way to avoid embarrassment and expensive audit issues is to use each CPT code only if the medical record content of the visit or procedure matches the definition for the code!
Charles B. Brownlow, OD, is an eyecare consultant and AOAExcel Medical Records and Coding Consultant. To contact him: AskTheCodingExperts@aoa.org.