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Time for 2012 coding changes, Medicare update

February 15, 2012

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

2012 is here and a new year always brings Medicare changes, new ICD-9 codes, and new procedure codes. Sometimes a new year also means the end for codes we’ve used for many years. Some of the insurance companies may not recognize and adopt the changes on Jan. 1, but all providers should be aware of and implement the changes as soon as they are in effect. Most of the changes were technically in effect on Oct. 1, and all should be implemented by now.

Rules for medical records

Let’s review the rules for choosing codes and submitting claims. First, there is only one official source for codes for office visits and procedures: Current Procedural Terminology (CPT). CPT is owned and copyrighted by the American Medical Association. The copyright essentially means that no CPT code should be used to describe a service unless the medical record of that service matches all the components of its definition in CPT. The codes should be chosen based purely upon what was done for the patient during the visit and therefore what was recorded in the patient’s record.

Second, International Classification of Diseases, ninth edition (ICD-9) is the only official source for the codes used to report the diagnosis or diagnoses that are germane to each visit or procedure. HIPAA rules require that all providers and all insurers use CPT and ICD-9. This requirement is intended to create standard “language” to be used in creating and considering claims. If all payers and providers know and apply these resources, it may be possible to eliminate disagreements as to whether a claim accurately reflects the care that was provided for a patient.

Sadly, many providers apparently are not accurately applying the rules and details of these references; just as sadly, neither are many insurers. The result can be long, stressful, expensive audits.

CPT and ICD-9 changes, 2012

CPT changes

Code 92070, fitting of contact lens for treatment of disease, has been deleted. It has been replaced by two new codes: 92071, fitting of contact lens for treatment of ocular disease, and 92072, fitting of contact lens for management of keratoconus, initial fitting. Each of these codes is unilateral, billed once for each eye, and each is for the professional services only. The lens should be reported separately, using the V codes or 99070.

Code 92120, tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method, has been deleted.

Code 92130, tonography with water provocation, has also been deleted.

ICD-9 changes

There have been changes in codes for use prior to the definitive diagnosis of glaucoma. Code 365.0, borderline glaucoma, has been joined by two new codes; 365.00, preglaucoma, unspecified, and 365.01, open-angle with borderline findings, low risk, open angle, low risk. The description of code 365.02, anatomical narrow angle, now includes new language, “primary angle-closure suspect.” ICD-9 has also added two additional glaucoma codes, 365.05, open-angle with borderline findings, open-angle, high risk, and 365.06, primary angle closure without glaucoma damage.

In addition to those changes, CPT has added a whole new set of codes to report the stage of each patient’s glaucoma. These 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, and
  • 365.74  Indeterminate-stage glaucoma

The glaucoma “stage codes” are reported only when glaucoma has been diagnosed, using codes 365.10-365.13, 365.20-365.23, 365.31, 365.52, and 365.62-365.65. Stage codes are not reported with any of the codes related to glaucoma suspects, 365.00-365.06. Determination of the stage of each patient’s glaucoma is left to the judgment of the doctor. For guidance, AOA members can refer to the Quick Reference Guide, Care of the Patient with Open Angle Glaucoma, Table 1. The guide can be found on the AOA Web site at http://www.aoa.org/documents/QRG-9.pdf for viewing and for download.

The AOA provides a wealth of information regarding CPT and ICD coding through the AOA Web site, www.aoa.org.

Medicare fee schedule

A very large decrease in Medicare fees (20 to 25 percent) was scheduled to take effect in 2012 without action by Congress to temper the reductions. Congress can affect the Medicare reimbursements by raising or lowering the “conversion factor,” which is multiplied by the “relative value” for each service to determine the fee for that service. The relative values for common eye care procedures did not change for 2012, so any increase or decrease in the conversion factor will transfer directly to Medicare’s allowed charge for each service.

Medicare patients’ annual deductible has decreased from $162 in 2011 to $140 for 2012. 

If you are confused or have any questions about the CPT and ICD changes for 2012, or other issues related to Medicare, other insurers, or record-keeping in general, submit your questions to askthecodingexperts@aoa.org. We’ll do our best to provide answers for you within two business days.

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