Ophthalmology and Optometry Coding Alert

The four-year phase-in period for practice-expense relative value units has ended, and ophthalmologist fees are up in the office but, for the most part, down in the operating room. In 2002, office-based eye codes and E/M codes have big increases, but hospital- or ambulatory surgical center-based procedures have decreases. Major procedures with many global-period postoperative visits have fewer reductions than major procedures with only a few postoperative visits.
 
For example, compare 66172 (fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma [includes injection of antifibrotic agents]), which has 12 postoperative visits, to 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]), which has the fewest. The payment for 66172 in 2002 is $1,139, up 17 percent from $974 in 1998, when the phase-in of new calculation methodology began. Cataract surgery, however, dropped 15 percent from $795 in 1998 to $670 in 2002. Procedures with an intermediate number of follow-up visits, such as 67108 (repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique) and 65755 (keratoplasty [corneal transplant]; penetrating [in pseudophakia]), have smaller decreases: 65755 dropped 3 percent from $1,118 in 1998 to $1,084 in 2002, and 67108 dropped 10 percent from $1,605 in 1998 to $1,445 in 2002.
  
Minor procedures performed in the office will have much higher fees  to reflect the ophthalmologist's overhead. For example, 65222* (removal of foreign body, external eye; corneal, with slit lamp) went from $52 in 1998 to $64 in 2002; 65430* (scraping of cornea, diagnostic, for smear and/or culture) from $78 in 1998 to $369 (a 473 percent increase) in 2002; 67228 (destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions; photocoagulation [laser or xenon arc]) from $790 in 1998 to $847 in 2002; 67800 (excision of chalazion; single) from $87 in 1998 to $148 in 2002; and 67908 (repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection [e.g., Fasanella-Servat type]) from $506 in 1998 to $777 in 2002.
 
The lacrimal probing codes (68801-68840) have been cut drastically; so has 68761 (closure of the lacrimal punctum; by plug, each). This is because of previous errors in the Fee Schedule . These codes included, among other errors, costs for supply for bipolar cautery ($89, not performed during lacrimal probing or punctal plug placement), a shield ($16.50), and paper towels ($15.50).
 
A big error caused 92225 (ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) to pay more than it should have. The price rose from [...]