ASK THE CODING EXPERTS: Codes and values for ophthalmic imaging

摘要

As previously reported in American Optometric Association (AOA) media, the Current Procedural Terminology (CPT) coding system recently deleted CPT 92135 for computerized ophthalmic diagnostic imaging (e.g., laser scanning). It was replaced by 2 codes: 92133 and 92134. CPT 92135 indicated that the procedure was unilateral, meaning the practitioner could bill for each eye on which the procedure was performed. The new codes indicate the procedure is bilateral. That means practitioners are entitled to only 1 payment even if they provide the procedure on both eyes. Reimbursement under Medicare for the new coding reflects the slightly higher physician work involved in scanning 2 eyes instead of 1, but overall the doctor will be paid only about 50percent as much if both eyes are scanned. A number of optometrists have contacted the AOA Clinical & Practice Advancement Group to ask why reimbursements for such an important diagnostic procedure have been effectively cut just as early detection and management of diabetic retinopathy and other retinal conditions are increasingly recognized as a national health care priority. The answer is the health care billing codes, and the values assigned to them, are developed based on specific formulae and procedures. This year, those formulae and procedures combined to deal ophthalmic diagnostic imaging a "triple whammy" that reduced reimbursement.