Ophthalmology and Optometry Coding Alert

Coding Quiz Answers:

Check Your Answers to Our End-of-Year Coding Quiz

Published on Tue Nov 22, 2022

Find out if your coding knowledge is up to date.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: As of Jan. 1, 2022, when the physician and a nonphysician practitioner (NPP) from the same practice group share an evaluation and management (E/M) visit, “the visit is billed by the physician or practitioner who provides the substantive portion of the visit,” according to CGS Medicare rep Vanessa Williams.

“For 2022, the substantive portion can be the history, physical exam, medical decision making [MDM], or more than half of the total time — except for critical care, which can only be more than half of the total time,” she notes.

You should append modifier FS (Split (or shared) evaluation and management visit) to the appropriate E/M visit code, Williams adds. This allows the Medicare Administrative Contractor (MAC) to see that the physician and the NPP shared the visit.

Answer 2: The 2023 ICD-10 code set introduces a plethora of new diagnosis codes pertaining to social determinants of health (SDoH). The expansion of the Z59.8- (Other problems related to housing and economic circumstances) code set enables you to capture the ways in which a patient’s health is affected by their social circumstances in much greater detail than before.

This update “allows for further specificity when coding for other problems related to housing and economic circumstances,” notes Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, senior consultant at Pinnacle Enterprise Risk Consulting Services LLC, in Centennial, Colorado.

“Prior to the expansion of Z59.8, everything rolled into the ‘other’ code. But the addition of a fifth digit — 2, 6, 7 — allows you to document transportation insecurity, financial insecurity, and material hardship,” Pritchett adds.

The three new codes and their inclusion terms are:

Z59.82 (Transportation insecurity): Includes excessive transportation time along with inaccessible, inadequate, lack of, unaffordable, unreliable, and unsafe transportation.
Z59.86 (Financial insecurity): Includes bankruptcy, burdensome debt, economic strain, financial strain, money problems, running out of money, and unable to make ends meet.
Z59.87 (Material hardship): Includes material deprivation and inability to obtain adequate childcare, adequate clothing, adequate utilities, and basic needs.

In addition, ICD-10 2023 contains new Excludes2 notes stating you can code extreme poverty (Z59.5), low income (Z59.6), or material hardship NEC (Z59.87) with Z59.86; and extreme poverty (Z59.5), financial insecurity (Z59.86), and low income (Z59.6) with Z59.87.

Answer 3: In keeping with the level one office/outpatient E/M code deletions of 2021, CPT^®will delete the lowest level office consultation code (99241) to align with four levels of MDM in 2023. Beginning Jan. 1, you’ll report 99242 for a consultation that involves straightforward MDM.

The updated consultation codes will allow providers to select the level of service based on MDM or time. Here are the office/ outpatient consultation E/M codes for 2023 with portions of the revised descriptors emphasized for easy reference:

99242 (Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.)

99243 (… low level of medical decision making … 30 minutes must be met or exceeded.)
99244 (… moderate level of medical decision making … 40 minutes must be met or exceeded.)
99245 (… high level of medical decision making … 55 minutes must be met or exceeded.)

Notably, references to the level of history and examination are deleted and substituted with “a medically appropriate history and/or exam,” which mirrors the changes made in 2021 to the descriptors for the office/outpatient visit codes. Unlike the codes for office/outpatient services, CPT^® does not specify a range of time for these consultation codes. Instead, the descriptors include a single time that must be “met or exceeded.”

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