The new Current Procedural Terminology (CPT) Category I codes effective for use on January 1, 2019 have been released. However, until those codes become “active,” they aren’t available to use and any instructions or guidelines for previous codes remain in effect. That’s important to know when you or a payer review your claims for compliance and documentation, since the actual date on which an event occurred drives appropriate coding. The same applies to the ICD-10 codes that undergo changes over time. You must follow the guidelines in effect for that date-of-service.
Let’s review the new 2019 CPT codes that are likely to appear in eye care and some of the important things to know about them.
Q: What are the new CPT codes for January 1, 2019?
A: Many codes have been added for use on January 1, 2019. There are quite a few affecting eye care. Here is a list of the most likely to be aplicable in an ophthalmology practice:
- 92273: Electroretinography (ERG), with interpretation and report; full field (e.g., ffERG, flash ERG, Ganzfeld ERG);
- 92274: Electroretinography (ERG), with interpretation and report; multifocal (mfERG);
- 0509T: Electroretinography (ERG) with interpretation and report; pattern (PERG); and
- 0514T: Intraoperative visual axis identification using patient fixation (list separately in addition to code for primary procedure).
Other new codes for eye care, which are less likely to be used in day-to-day practice include:
- 11102: Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion;
- 11103: Each separate/additional lesion (list separately in addition to code for primary procedure).
(Report 11103 in conjunction with 11102, 11104 and 11106 when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used.)
- 11104: Punch biopsy of skin (including simple closure, when performed); single lesion; and
- 11105: Each separate/additional lesion (list separately in addition to code for primary procedure).
(Report 11105 in conjunction with 11104 and 11106 when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used.)
- 11106: Incisional biopsy of skin (e.g., wedge) (including simple closure when performed); single lesion.
- 11107: Each separate/additional lesion (list separately in addition to code for primary procedure).
(Report 11107 in conjunction with 11106.)
There are also codes that are to be deleted and will no longer be available for use after December 31, 2018. These include: 92275, electroretinography with interpretation and report; and 0190T, placement of intraocular radiation source applicator (list separately in addition to primary procedure).
Q: I’ve heard that some codes were released midyear (for use on claims for July 1, 2018 and afterwards). If so, what are those codes?
A: That’s true. Although CPT Category I codes are only released for use on January 1, Category III codes are released twice a year (January and July). Those “midyear 2018” codes include:
- 0506T: Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report; and,
- 0507T: Near infrared dual imaging (e.g., simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report.
Note: There is a parenthetical note below this code to use CPT 92285 for external ocular photography, and to use CPT Category III code 0330T with tear-film imaging.
Q: There are a number of electroretinography code changes. Does CPT give any special instructions related to their use?
A: Yes. The 2019 CPT books state, “Electroretinography (ERG) is used to evaluate function of the retina and optic nerve of the eye, including photoreceptors and ganglion cells. A number of techniques that target different areas of the eye, including full field (flash and flicker, 92273) for a global response of photoreceptors in multiple separate locations in the retina, including the macula, and pattern (0509T) for retinal ganglion cells are used. Multiple additional terms and techniques are used to describe various types of ERG. If the technique used is not specifically named in the code descriptions for 92273, 92274 or 0509T, use the unlisted procedure code 92499.”
Essentially, this means that clinicians should use the code associated with the technique used to do the ERG test—but if you are using another technique, you must use the “unlisted ophthalmological service or procedure” code (92499). If you must do that, payer coverage for 92499 is likely to be uncertain or not forthcoming at all, and you should execute a financial waiver (ABN if Part B Medicare) and be prepared to collect from the patient. Price this potentially noncovered service accordingly based on the cost of delivering.
Q: Why can’t I continue to use CPT 92285 when I take a meibomian gland image?
A: CPT has always directed that when a specific code exists, it must be used. It’s even possible that the code you used to use might have had coverage but the new, more specific code might not have coverage.
If you’re not using near infrared imaging for the meibomian gland image (for example, a color image reveals a lid-margin tumor and you’re monitoring it for change in the future), then 92285 still applies; it will likely be covered by payers if otherwise medically necessary. However, once you use near infrared imaging of the meibomian glands, then Category III code 0507T applies (not 92285)—which is unlikely to have coverage. Of course, the parenthetical note accompanying the code states to use another code (0330T) if you’re imaging the tear film.
Q: I’ve never heard of macular pigment optical density measurement. What does that refer to?
A: This is a special test for the density of the retinal pigments zeaxanthin and lutein and the metabolite meso-zeaxanthin, which help shield the retina from damage from short wavelength, high-energy light, which might otherwise contribute to the development of age-related macular degeneration. Knowledge of changes to pigment density over time might help with assessing whether diet or antioxidant supplementation can diminish the harmful effects of these wavelengths.
New Category III code 0506T applies when this is done via heterochromatic flicker photometry. Photometry is noninvasive and unlikely to be a covered service at this point, so execute the appropriate financial waiver or ABN and collect from the patient.
Q: Do we know what the new code “bundles” are yet?
A: That’s not known since the quarterly release of the NCCI files for January 2019 wasn’t yet available as of this writing. Be sure to check.
Q: What about reimbursement under Medicare for the new codes?
A: All Category I codes have a payment under the Medicare Physician Fee Schedule for 2019. For the Category III codes, each Medicare Administrative Contractor decides both coverage and pricing, so expect no coverage at first for the newer codes. REVIEW
Mr. Larson is a senior consultant at the Corcoran Consulting Group. Contact him at firstname.lastname@example.org.