Ophthalmology and Optometry Coding Alert

CPT 2008 will add reference times to several E/M code categories -- specifically nursing facility care (99304-99310) and annual nursing assessments (99318) -- that did not previously include them. The addition of a reference time means that, when necessary and supported by documentation, you may select an E/M service level using time, rather than the history, exam and medical decision-making key components, as the primary deciding factor. Warning: You'll have to await CMS guidance to see if you can report these new codes simultaneously with prolonged service codes when time becomes prolonged and is also the primary coding factor for a visit in a nursing facility. Additionally: CPT 2008 also lists two codes (99406 and 99407) that will deal with counseling patients on how to quit smoking, while two others (99408 and 99409) will describe alcohol and/or substance (other than tobacco) abuse structured screenings and interventions. You likely won't be using these codes in your ophthalmology practice. The final new E/M code in CPT 2008, 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services), describes services less intensive than those outlined by neonatal critical care code 99295 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less) but presumably more intensive than those services included in a standard initial inpatient care code (99221-99223).