Coding Update for Medicare - 2010

INTRODUCTION

A Happy and Healthy New Year to all!
NEW CPT (Current Procedural Terminology) CATEGORY I CODES
There are no Category I CPT codes for 2010 in the Eye and Ocular Adnexa Section; however, there are prefatory description changes as noted separately.
For those of you involved with Oculoplastic Surgery there are changes in the Integumentary section that should be reviewed.
The following new codes are listed:
• 14301 Adjacent tissue transfer or rearrangement any area: defect 30.1 sq cm to 60.0 sq cm
• 14302 each additional 30.0 sq cm or part thereof (List separately in addition to code for primary procedure)
• Review the preface to Excision – Benign Lesions and Excision – Malignant Lesions
The revised instructions for Integumentary System - Adjacent Tissue Transfer or Rearrangement are listed under description revisions.
The complex retinal detachment repair code (67113) may be used with 66990 (use of ophthalmic endoscope). Note that this is a special instrument and is not the usual instrument used for “focal endolaser photocoagulation” or “endolaser panretinal photocoagulation”.

DELETED CPT CODES

There are no deleted Category I codes for 2010 under the Eye and Ocular Adnexa Section.
Under Integumentary System CPT code 14300 has been deleted. To report, see 14301.

CATEGORY III (EMERGING TECHNOLOGY) CODES

The Category III codes are actually updated every 6 months and can be accessed online at the AMA Web site www.ama-assn.org. This is somewhat confusing due to the vagaries of the system. The implementation date occurs 6 months after the release date. The appearance of the code in CPT depends on the cycle. You may begin using the code on the implementation date even though it does not appear in that year’s CPT book.
The following are the new Category III codes appearing in CPT 2010.
l0198T Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report
l0207T Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral

CATEGORY I DESCRIPTION REVISIONS

Consultations. While Medicare has eliminated both outpatient and inpatient consultation codes, other insurers may still allow them. The code sets still appear in CPT 2010 and there have been minor revisions in descriptions. Be sure to take a look at them.
Ophthalmic Endoscope.
66990 Use of ophthalmic endoscope (List separately in addition to code for primary procedure)
(66990 may be used only with codes 65820, 65875, 65920, 66985, 66986, 67036, 67039, 67040, 67041, 67042, 67043, 67112, 67113)
Repair of Retinal Detachment.
Prophylaxis. Codes 67141, 67145 include treatments at one or more sessions that may occur at different encounters. These codes should be reported once during a defined treatment period.
Destruction. Codes 67208, 67210, 67218, 67220, 67227, 67228, 67229 include treatment at one or more sessions that may occur at different encounters. These codes should be reported once during a defined treatment period.
Tonography - Note for 92120. For measurement of ocular blood flow, use Category III code 0198T.
Adjacent Tissue Transfer or Rearrangement. Codes 14000-14302 are used for excision (including lesion) and/or repair by adjacent tissue transfer or rearrangement (eg, Z-plasty, W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap). When applied in repairing lacerations, the procedures listed must be performed by the surgeon to accomplish the repair. They do not apply to direct closure or rearrangement of traumatic wounds incidentally resulting in these configurations. Undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer, see complex repair codes
13100-13160. The excision of a benign lesion (11400 – 11446) or a malignant lesion (11600-11646) is not separately reportable with codes 14000 – 14302.
OIG WORKPLAN 2010 (http://oig.hhs.gov/publications/docs/workplan/2010/Work_Plan_FY_2010.pdf)
Some of the issues Office of the Inspector General will be auditing for: ASC place of service errors; E/M services performed in the global period; use of the GY modifier.

ABOUT THE AUTHOR

Riva Lee Asbell, an ophthalmic reimbursement consultant, is the principal of Riva Lee Asbell Associates in Philadelphia.