Article

Coding & Reimbursement

What’s new in CPT for 2020?

Every year, changes to CPT coding occur that affect ophthalmology, and 2020 is no exception. Here are some of the most important changes.

Q. What code changes affect ophthalmic surgery in 2020?

A. Endoscopic cyclophotocoagulation (ECP) and cataract surgery may no longer be reported together.

  • Change 66711: Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
  • Change 66982: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
  • Change 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
  • Add 66987: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation
  • Add 66988: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation

Q. What about diagnostic tests?

A. Extended ophthalmoscopy gets a radical change. The service has been completely redefined and the concept of “initial” and “subsequent” goes away.

  • Add 92201: Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral
  • Add 92202: Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral
  • Delete 92225: Extended ophthalmoscopy, initial
  • Delete 92226: Extended ophthalmoscopy, subsequent

We are also instructed not to bill 92201 or 92202 with fundus photography (92250). Many payers have had this as a policy for a long time, or at least required that a clearly unrelated condition exist, but now this is enshrined in CPT. You can be sure Medicare and other payers will adopt this as part of their policies.

Q. Are there other changes?

A. Yes. Category III codes have one delete, one change and one add.

  • Delete 0341T: Quantitative pupillometry
  • Change 0402T: Collagen cross-linking of cornea, including removal of the corneal epithelium and intraoperative pachymetry, when performed (report medication separately)
  • Add 0563T: Evacuation of meibomian glands, using heat delivered through wearable, open-eyelid treatment devices and manual gland expression, bilateral

For 0402T, CPT now instructs that the medication be reported separately. Note that 0402T is described as “epi-off”; there is still no code for “epi-on” corneal cross-linking.

For evacuation of meibomian glands, CPT reminds us that when only manual expression is performed, there is not a separate code — it is part of the office visit.

Q. How do these changes affect reimbursement?

A. We already know that cataract surgery values for the surgeon have dropped due to CMS recalibrating the number of postoperative visits included in the relative value units. But ECP also took a hit in 2020 (see Table below).

Table. 2020 reimbursement changes (* MAC priced)
Code Surgeon ASC HOPD
2019 2020 2019 2020 2019 2020
66711 $658.79 $513.56 $977.33 $1,012.72 $1,917.16 $2,021.64
66982 $813.04 $765.10 $977.33 $1,012.72 $1,917.16 $2,021.64
66984 $654.47 $557.58 $977.33 $1,012.72 $1,917.16 $2,021.64
66987 N/A * N/A $2,392.91 N/A $3,817.90
66988 N/A * N/A $2,392.91 N/A $3,817.90
92201 N/A $28.15 N/A N/A N/A N/A
92202 N/A $25.98 N/A N/A N/A N/A
0402T * * $805.14 $836.94 $1,812.68 $1,934.99

While facility fees for the new combined codes are known, CMS decided to let the contractors set the value for the surgeon; we won’t really know the effect until claims are being processed. Our guess is that it will be more than either ECP or cataract surgery, but less than the former combined allowable. OM