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Get up to speed with the latest changes in medical records coding for 2013

December 26, 2012

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

As the year draws to a close, it’s important for all health care providers to become familiar with the 2013 changes in the new main references for medical record keeping: Current Procedural Terminology (CPT ©American Medical Association) and International Classification of Diseases, 9th Edition.

The AMA CPT and ICD-9 are the ONLY coding references for diagnosis codes, visits, and procedures that are accepted by Medicare and Medicaid and the only coding references required by HIPAA.

In preparation for accurate medical records and coding for next year, it is critical that you have the 2013 edition of CPT.

Your communication with insurers and accurate choices of procedure codes depends upon your having the current Current Procedural Terminology and not one that is one, five or 15 years old.

It’s also important that you purchase the only official CPT, the one that is prepared, published, and copyrighted by the American Medical Association (AMA).

You also need to have the current AMA CPT available to assist you if and when you are dealing with auditors from Medicare or other insurers.

Other publishers’ “versions” of CPT are available, but they may distort the true definitions and should not be depended upon for accuracy. In daily use in your practice and definitely during an audit, the AMA’s CPT is what you need.

AMA CPT is available to AOA members at AMA members’ prices through the AOA Order Department at 800-262-2210.

The following is a summary of key changes in 2011, 2012 and 2013 editions of CPT:

  • 2011

92135—retinal imaging, “unilateral,” was deleted and replaced by three new codes, each classified “unilateral/ bilateral”:
92132—Anterior segment imaging
92133—Imaging, Optic Nerve
92134—Imaging, Retina

Note: Medicare’s reimbursement for the each of the new codes is nearly identical for both eyes to previous reimbursement for 92135 for one eye! It is acceptable to bill the same, whether the test is done on one eye or both (per recent CPT Assistant ©AMA update). No modifier is required as there will not be any adjustment to reimbursement, up or down.

CPT added two codes used primarily by physicians taking fundus photos of patients with systemic diabetes and sending them to a remote “reading center” to analyze the presence or progression of retinal disease.

92227—Remote imaging for the detection of retinal disease…unilateral or bilateral

Note: Do not report 92227 in conjunction with 92002-92014, 92133, 92134, 92250, 92228 or with the evaluation and management of the single organ system, the eye, 99201-99350.

92228—Remote imaging for monitoring and management of active retinal disease…unilateral or bilateral

Note: Do not report 92228 in conjunction with 92002-92014, 92133, 92134, 92250, 92227 or with the evaluation and management of the single organ system, the eye, 99201-99350.

  • 2012

CPT deleted two eye care codes in 2012 after surveying providers and finding few, if any, physicians actually doing either of the procedures. They are 92120—Tonography and 92130—Tonography with water provocation.

Note: Use the CPT Category 3 code, 0198T, to report ocular blood flow measurements.

Another code, 92070—Fitting of contact lens for treatment of disease, including supply of lens, was deleted and replaced with two new codes: 92071—Fitting of contact lens for treatment of ocular surface disease (also used for bandage contact lens) and 92072—Fitting of contact lens for management of keratoconus, initial fitting.

Note: According to CPT Assistant (©AMA) “report supply of lens separately with 99070 or appropriate supply code,” e.g. HCPCS code

  • 2013

Several codes had language changes for 2013, though the numbers stayed the same.

For your reference, we’ve put the new or additional wording in bold italics and have used strike through for deleted language:

  • 92015, Determination of refractive state (For instrument-based ocular screening, use 99174)
  • 92132, Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. For specular microscopy and endothelial cell analysis, use 92286.
  • 92286, Anterior segment photography imaging, with specular microscopy and endothelial cell count analysis
  • Changes in definitions for 92002, 92012, 92004, 92014 include: “Interpretation and report by the physician or other qualified health care professional is an integral part of special ophthalmological services where indicated…” and “(For distinguishing between new and established patients, see Evaluation and Management guidelines)

Note: those guidelines are found at the front of the CPT manual.

  • In the section “Spectacle Services (Including Prosthesis for Aphakia)…. When provided by the physician, fitting of spectacles is separate service when provided by the physician and is reported as indicated by 92340-92371…Presence of the physician or other qualified health care professional is not required.”
  • Ophthalmic Surgery Code Changes, 2013

Note: Some of these codes may not be common in optometric practice and are provided in the interest of complete reporting.

65805, Deleted, replaced with:

65800—Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous, and in the definition of the code

67810—Incisional biopsy of eyelid skin including lid margin, “(for biopsy of skin of the eyelid, see 11100, 11101, 11310, 11313)

Note: There are no changes in International Classification of Diseases for 2013 or 2014! It is also important to note that there are no changes in ICD-9 codes for 2013, nor will there be any in 2014. The next change in diagnosis coding will be the big one, when ICD-10 becomes the “law of the land” on Oct. 1, 2014.

In-office preparation for medical record-keeping and coding, 2013

All doctors and key staff should read the 2013 CPT definitions for your practice’s 20 to 30 most commonly billed services. It’s clear that many doctors and coding staff have never read the CPT definitions and are possibly misusing CPT codes.

Clear and thorough knowledge of CPT coding for 2013 is only possible if you have the 2013 AMA CPT.

The only way to avoid embarrassment and expensive audit issues is to use each CPT code only if the medical record content of the visit or procedure matches the definition for the code!

2 comments

  1. Regarding the use of 97000 therapy codes, articles state there must be an Individual Rehab Plan (IRP) in the chart. Is this IRP a separate report or is it that the 9 elements of an IRP must be found somewhere in the chart? I haven’t been able to find an IRP template.


  2. You can check this document for guidance if it is in there.

    https://newsfromaoa.files.wordpress.com/2013/02/insurance-vision-therapy-and-neuro-optometric-rehabilitationaoa-approved-1-31-2013-branded_v21.pdf

    Additionally, any of the Medicare LCD’s that have a vision rehabilitation policy, have the nine points listed. I would suggest checking with your local carrier. Most state that the information must be integral to the patients chart.



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