Ophthalmology and Optometry Coding Alert

Plus: You’ll find revisions to other eye imaging codes in 2021.

As eye care practices prepare for the well-publicized updates to the E/M section of CPT^®, it’s important to remember that a few other changes will also be headed your way when the new code set takes effect on Jan. 1, 2021. That’s because CPT^® 2021 includes over 300 changes, several of which will be of great interest to ophthalmology and optometry practices.

Prep for Adjustments to Eye Imaging Codes

Among the most significant updates affecting eye care coders is the new addition to the retinal imaging category, which allows you more specificity in your code choices.

Breakdown: Effective Jan. 1, you’ll find new code 92229 (Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral) to describe the retinal imaging reviews you perform when monitoring for specific diseases, such as diabetes.

As a result, the previous codes in the series have been revised, with the new descriptors as follows:

• 92227 (Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral)
• 92228 (…with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral)

New code 92229 allows you to accurately code when the eye care provider screens patients using augmented intelligence technology, while still allowing practices to use more traditional methods with the newly revised codes. The changes “better support the screening of patients for diabetic retinopathy and increase early detection and incorporation of findings into diabetes care,” said the AMA in a Sept. 1, 2020 press release on the changes.

Get a Handle on Prolonged Service Codes

In addition to the retinal imaging codes and the E/M changes that eye care practices have been expecting, CPT^® 2021 will add new prolonged services code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)).

You should report +99417 “to report prolonged total time (ie, combined time with and without direct patient contact) provided by the physician or other qualified health care professional on the date of office or other outpatient services (ie, 99205, 99215),” according to CPT^®. However, you should only report +99417 “when the office or other outpatient service has been selected using time alone as the basis and only after the total time of the highest-level service (ie, 99205 or 99215) has been exceeded.”

Don’t miss: For all other non-office/outpatient E/M code sets that may be reported based on the 1995/1997 guidelines for time-based coding, you’ll continue to use the existing prolonged services code range +99354-+99357 (Prolonged service with direct patient contact).

In terms of the updated E/M code set, remember to read over the new guidelines so you can code accurately, said AMA President Susan R. Bailey, MD, in a Sept. 1 news release about the updates to the 2021 code set. “To get the full benefit of the burden relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT^® codes and guidelines by Jan. 1, 2021,” she said.

Keep an eye on future issues of Ophthalmology and Optometry Coding Alert for more details about how to use the adjusted code set as information is released.