Ophthalmology and Optometry Coding Alert

Fortunately, the latest edition of CPT^® isn’t as earth-shattering as last year’s.

When the 2021 CPT^® codes were revealed last fall, ophthalmology coders faced a steep learning curve. That’s because the massive changes to the outpatient E/M code set caused coders to have to learn entirely new coding conventions and guidelines. Fortunately, the updates for 2022 aren’t anywhere near as comprehensive. Instead, you’ll just have to make a few adjustments so you can be up to date with the latest codes and descriptors before the new year hits.

Among the most relevant changes for eye care practices are a tweak to the descriptor for 99211, a new code for drug-eluting implant insertions, and revisions to the retinal detachment treatment codes. Read on to get some detailed knowledge on these respective changes so you can be prepared before the calendar turns to 2022.

Check This E/M Update

You’ll recall that CPT^® 2021 removed the time component from the 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal) descriptor, which previously said, “Typically, 5 minutes are spent performing or supervising these services.”

For 2022, the AMA has further truncated the code descriptor, which now reads, “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.” What’s missing is the previous verbiage stating, “usually, the presenting problem(s) are minimal.”

In the 2021 E/M guidelines, the AMA released its definition of “minimal,” noting that a minimal problem was one “that may not require the presence of the physician or other qualified health care professional, but the service is provided under the physician’s or other qualified health care professional’s supervision.”

Therefore, it’s possible that the AMA removed the “presenting problem(s) are minimal” terminology from the 99211 descriptor because it’s redundant, considering that 99211 is already meant to describe a service defined similarly to how the AMA defines a minimal problem.

Check Revisions to Retinal Detachment Codes

When it comes to the surgical codes, the 2022 updates are somewhat tame, other than a few revisions to the verbiage of retinal detachment codes, as follows:

• 67141 (Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; cryotherapy, diathermy) has been changed, with a strikethrough demonstrating the verbiage that will be deleted effective January 1.
• 67145 (Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc)) has been revised, with the deleted verbiage shown under the strikethrough.

According to the 2022 Medicare Physician Fee Schedule Proposed Rule, which was published July 23, “the codes were edited to remove the reference to ‘1 or more sessions’ so that the services may be valued as a 10-day procedure versus the current 90-day global.” This could explain the reason for the change and the impetus for removing the verbiage regarding the number of sessions involved.

You’ll also find a brand-new code describing a drug-eluting implant procedure involving the eye:

• 68841 (Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each)

This service was previously described using Category III code 0356T (Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each), but that code will be deleted effective January 1. You’ll use 68841 when the surgeon places a corticosteroid insert into the canaliculus to deliver dexamethasone (brand name Dextenza) to treat pain and inflammation following eye surgery.

Stay tuned as the AMA releases more details about the new, revised, and deleted codes for 2022 — Ophthalmology and Optometry Coding Alert will continue to report on the updates as more information is released.