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Coding & Reimbursement

It’s that time again: Coding news for the new year

Every year, we deal with changes to CPT coding that affect ophthalmology. While those for 2019 aren’t as extensive as we’ve seen in years past, there are some. Here’s what you need to know.

Q. What code changes affect ophthalmology in 2019?

A. There are no changes to ophthalmic surgery codes; however, there are changes to ophthalmic medicine codes.

Firist, electroretinography (ERG), which is not a common ophthalmic test. It is most useful for neurologists, neuro-ophthalmologists and some retina specialists. Reading and interpreting ERGs is subtle and complex, requiring special training and expertise. Historically, these specialists are often associated with teaching institutions or large groups that receive requests for consultations on neurological cases, so the specialized equipment, dedicated testing room and trained technicians needed to perform these tests can more readily be justified. Technological advances have made electrophysiology testing faster, simpler and more accessible in recent years.

In 2019, ERG coding gets some significant changes (See Table 1).

Table 1. Electroretinography
Add 92273 Electroretinography with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG)
Add 92274 Electroretinography with interpretation and report; multifocal (mfERG)
Add 0509T Electroretinography with interpretation and report, pattern (PERG)
Delete 92275 Electroretinography, with interpretation and report

Also, ERG coding in CPT gets an extensive new discussion: “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, 0509T, use the unlisted procedure code 92499.”1

Q. What about other codes?

A. The year introduces several Category III codes and deletes one code (Table 2).

Table 2. Category III codes
Add 0506T Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report
Add 0507T Near infrared dual imaging (i.e., simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report
(Use 92285 for external ocular photography)
(Use 0330T for tear film imaging)
Add 0509T Electroretinography (ERG) with interpretation and report, pattern (PERG)
Add +0514T Intraoperative visual axis identification using patient fixation
(List separately in addition to code for primary procedure)
Delete 0190T Placement of intraocular radiation source applicator
(List separately in addition to primary procedure)

Q. Anything else of interest?

A. The language in CPT about skin “biopsy” and what that means has changed.

It is much more detailed in describing each type of biopsy (shave/curette, punch, incisional). It also is very clear that a biopsy is a stand-alone procedure — do not bill biopsy with an incision, say, just because the tissue was sent to pathology.2 In part, it reads:

“The use of a biopsy procedure code (e.g., 11102 – 11107) indicates that the procedure to obtain tissue solely for diagnostic histopathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time. Biopsies performed on different lesions or different sites on the same date of service may be reported separately, as they are not considered components of other procedures.

During certain surgical procedures in the integumentary system, such as excision, destruction, or shave removals, the removed tissue is often submitted for pathologic examination. The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. This obtaining of tissue is not considered a separate biopsy procedure and is not separately reported.”

Skin biopsy gets new codes as well (Table 3). OM

Table 3. Skin biopsy
Add 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion
Add 11103 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); each separate/additional lesion
(List separately in addition to code for primary procedure)
(Report 11103 in conjunction with 11102, 11104, 11106 when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used)
Add 11104 Punch biopsy of skin (including simple closure, when performed); single lesion

REFERENCES

  1. Current Procedural Terminology (CPT). American Medical Association. CPT 2019 Professional Edition; 651, 787.
  2. Current Procedural Terminology (CPT). American Medical Association. CPT 2019 Professional Edition; 80-82.