Heads Up Part 2! New ICD for glaucoma and new CPT codes have arrived

January 25, 2012

Edited by Chuck Brownlow, O.D., Medical Records consultant

As usual, Current Procedural Terminology and International Classification of Diseases—9th Edition have introduced new codes. Some insurers began requiring the new codes be used as of Oct. 1, 2011; others will begin requiring them Jan. 1, 2012; and still others will straggle along and possibly not recognize any changes until late in the first quarter of 2012. It’s usually best to adopt the new codes as early as possible, Begin using them on your claims and continue to use them unless a specific insurer clarifies that they want you to continue to use the outdated codes.

Here are the new CPT code changes plus new codes for reporting glaucoma:

  • 2012 CPT, 92000 Series, Ophthalmological Services.

Three codes in the 92000 code series have been deleted:
 92120, tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method
 92130, tonography with water provocation
 92070, fitting of contact lens for treatment of disease, including supply of lens.

Code 92070 is replaced by two new codes:
 92071 Fitting of contact lens for treatment of ocular surface disease
 92072 Fitting of contact lens for management of keratoconus, initial fitting

Note: Supply of lens is not included in either of these new codes. Use 99070* or other appropriate supply code to report the lens type and material used; e.g., the HCPCS V code

*99070, supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided).

Decisions relative to deleting, revising and/ or adding specific codes are made by the CPT Editorial Panel, aided by surveys of physicians familiar with the services described by those codes. Input is also provided by the CPT Advisory Panel, and by the American Medical Association Health Care Professionals Advisory Committee, of which AOA volunteer Doug Morrow, O.D., is a member, assisted by CPT Alternate Adviser Rebecca Wartman, O.D.

Optometrists and ophthalmologists are included in the survey process for codes in the 92000, ophthalmological services, series, of course.

Codes may be deleted for various reasons, including when they are replaced by other codes, when the procedure is no longer in common use, when previous codes or descriptions had been confusing, etc.

2011 ICD-9 update

Changes for glaucoma codes include some new codes and some with revised definitions:

  • 365.0  Borderline glaucoma (glaucoma suspects) revised to now include added language:
     “365.01  Open-angle with borderline findings, low risk” and
     “365.02  Anatomical narrow angle, primary angle closure suspect.”

Additionally, two new codes have been added:
 “365.05  Open-angle with borderline findings, high risk” and
 “365.06 Primary angle closure without glaucoma damage”

A new set of codes for reporting the “stage” of the disease must be reported in addition to the appropriate glaucoma diagnosis code. 

These new codes are used only for patients who have been diagnosed with glaucoma and not for those who are glaucoma suspects.

The additional codes (ICD-9 365.70-365.74) are reported on each visit or procedure, in addition to the ICD code for the type of glaucoma. 

The new “Stage” codes are:
 365.70 Glaucoma stage, unspecified. Glaucoma stage NOS.
 365.71 Mild stage glaucoma. Early stage glaucoma
 365.72 Moderate stage glaucoma.
 365.73 Severe stage glaucoma. Advanced stage glaucoma. End stage glaucoma.
 365.74 Indeterminate stage glaucoma

The codes used for reporting the type of glaucoma and for which the appropriate new “stage” code must be added are:
 365.1 Open-angle glaucomas
 365.10 Open-angle glaucoma, unspecified
 365.11 Primary open angle glaucoma
 365.12 Low tension glaucoma
 365.13 Pigmentary glaucoma

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