Ophthalmology and Optometry Coding Alert

With only three months to go until 2001, its time to be sure youre ready for the two main proposed revisions to payment policies under the Medicare Physician fee schedule for the new year. One is a decrease in relative value units (RVUs), and the other is a new code for photodynamic therapy (PDT).

New Codes and Values

There are now codes and RVUs proposed for PDT, as well as codes for tracking purposes for experimental procedures, including transpupillary thermal therapy (TTT), destruction of macular drusen by photocoagulation and feeder-vessel technique photocoagulation. The Health Care Financing Administration (HCFA) assigns tracking codes to follow the extent to which ophthalmologists are providing these experimental services.

Tracking codes are important because without them physicians must use the unlisted code, which does not describe the services.

The proposed rule also includes a crosswalk from 67220 (destruction of localized lesion of choroid [e.g., choroidal neovascularization], one or more session, photocoagulation [e.g., laser, ocular photodynamic therapy]) to 67208 (destruction of localized lesion of retina [e.g., macular edema, tumors], one or more sessions; cryotherapy, diathermy). This corrects an anomaly left over from last Novembers Medicare fee schedule, in which 67220 did not have a cost assigned to it.

The calculation of practice expense RVUs as proposed by HCFA would, if adopted, decrease total allowed charges for ophthalmologists by one percent, according to the American Society of Cataract and Refractive Surgery. This is due to a correction in the supply lists for some in-office codes, as well as a recalculation of the practice expense per hour.

PDT Changes

For CPT 2000, PDT was added to the descriptor of 67220. PDT, however, is significantly different from photocoagulation, according to the Medicare fee schedule released in July. Therefore, HCFA is proposing to establish two new HCPCS codes: one for photocoagulation, and one for PDT. The new codes and descriptors would be as follows.

Gxxx5: (destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photocoagulation [e.g. by laster], one or more sessions)

The above code would be used in place of 67220 for Medicare patients.

Gxxx6: (destruction of localized lesion of choroid [e.g., choroidal neovascularization: ocular photodynamic therapy [includes intravenous infusion])

The above code would be used for PDT for Medicare patients. As indicated, it will include the cost of administering the Visudyne, but not the cost of the drug itself.

Note: For more on PDT and Visudyne see preceding article HCFA Wants 67299 for PDT.

Although there are no CPT codes currently for the above services, there will be. When HCFA is waiting for a code to be approved for CPT, the agency commonly assigns the service a HCPCS code as a temporary measure. [...]