FAQs on Ophthalmology Coding Updates

Do Ophthalmology coding updates make your billing easy, compliant and profitable? How well are you informed regarding Ophthalmology coding updates? Sometimes coding updates and guidelines might cause confusion in the minds of healthcare professionals as its difficult task to perform. A comprehensive way as well as easy to learn and understand new and revised Ophthalmology coding guidelines and updates.

Healthcare professionals will have more impact and benefits from the Centers for Medicare and Medicaid Services which allows them to focus more on patient care instead of paper work. The documentation of evaluation and management services had covered Ophthalmology from the time special eye code levels loss in 90s.

Here are few answers for the most confused questions. Let’s have a look!

1.Eye exam codes will be changed this year. Is that true?

  • Obviously, every year coding updates take place. The Centers for Medicare and Medicaid Services introduces new rules and guidelines for coding each year with a motive to keep healthcare professionals compliant and reduce the burden of paper work.
  • The same happened this year too. The change is really essential. Most importantly the changes occurred to evaluation and management outpatient and office based exam codes. Those codes include 99202 to 99205 and 99212 to 99215.
  • The history and exams are eliminated among the key components while using the above codes for E/M coding services. Though they are essential for documentation and reasoning the visits and proof, medical decision making becomes more important except for inpatient exam codes.

2.What happens to Medicare payments for eye exams 2021?

  • In Ophthalmology coding, for medical visits, the proposed rule especially focuses on large changes in which healthcare professionals will be paid or reimbursed next year. It’s not the end but the eye codes including 92002 to 92014 will lose the value simultaneously.
  • New patient E/M codes 99202 to 99205 also has the chances to decrease but established patient E/M codes 99212 to 99215 are all thought to increase significantly in payments.
  • Healthcare professionals must wait to see the final rule and payment announcement in the first week of December.

3.The Decrease in the codes above doesn’t seem great. Does it have any alternative plans?

  • Few important things to remember include that the average eye practice involves about 80% of established patients and 20% new patients.
  • Though eye codes are decreasing, healthcare professionals must keep in mind that E/M codes are still possible and often commit for larger payments in 2021. But, only when the patient is an established one.
  • Shifting from eye codes to E/M codes can increasingly benefit the potential revenue reimbursements.

4.How about Eye exam codes? Is there a chance to yet find better payments on eye code and are the rules changing?

  • The most common eye exam codes used are 92002, 92004, 92012, and 92014 which does not bring any changes in the documentation and coding requirements. Also there’s no other way to change them.
  • If healthcare professionals find eye codes paying better than E/M codes, it’s their choice to stick to it.

5.The level 1 exam codes are deleted. Is that true?

  • In Ophthalmology coding for 2021, evaluation and management services codes have been deleted accompanied with consequences as most of the healthcare professionals hesitate and won’t use these codes.
  • For established patients, 99211 remains the same and is not much influenced or impacted as it’s not healthcare professionals’ exam code.
  • However, payments remain low even though it can be used in certain circumstances where it suits or fits.

6.Will the implementation be delayed? How likely would that happen?

  • It’s evident that implementation takes place or occurs highly. A delay can’t be handled. It would be really improbable.
  • American Medical Association and CPT supports the changes occurred. Secondly if the changes continue, it will be followed by other insurance companies or payers as well. It’s important for healthcare professionals to be ready.

7.Are new E/M rules de-emphasizing the history and exam?

  • The new 2021 rules and guidelines actually note that these two key components in the last year’s rules turned out to be medically appropriate.
  • The healthcare professionals decide what’s necessary for the patient during the time of encounter or visit. Of course, liability concerns occur and are a common factor in each of these areas that can’t be ignored.

8.If there are two ways to choose evaluation and management services codes in 2021, what are they?

  • To the matter of fact, the discussed topic is true. There are two ways to choose E/M codes in 2021. The most common way to use E/M codes is medical decision making.
  • The other way to use E/M codes is Time. The time used by healthcare professional and patient during the day of encounter or service or visit.
  • Of course, each has been redefined in their own significant ways.

9.How is coding through E/M Is different from coding via time?

  • Time is where healthcare professionals spend on exam for both face to face interaction and non-face to face interaction counts if it has not been differently reimbursed.
  • In Ophthalmology coding, coding by time for a new patient starts at 15 minutes and for established it’s 10 minutes.
  • If the value decreases, it’s not possible to code using E/M. Eye code don’t have such options.

2022 Ophthalmology Coding: What’s new?

The ICD-10 coding changes for the ophthalmology services have not gone drastic changes for the year 2022. However, there are still quite a few descriptor changes and deletion of codes that you need to update in your coding workflow to stay current with the latest guidelines. Here are some vital updates on ophthalmology coding in 2022:

  • Descriptor for the 99211 code was slightly changed with the removal of the term “presenting problem(s) are minimal.”
  • The 2021 update to E/M guidelines defined the use of the term “minimal” as a procedure requiring the supervision of a healthcare professional but not the necessary presence of a physician. Experts believe that the removal of the code descriptor is an extension of this guideline since the term is now redundant.
  • Code 67141 suffered the deletion of the term “1 or more sessions.” According to the 2022 Medicare Physician Fee Schedule Proposed Rule, the service can now be brought under the umbrella of a 10-day procedure instead of a 90-day global.
  • The term “1 or more sessions” was also deleted for the code 67145 in addition to the deletion of “laser or xenon arc” due to the same reason.
  • A new code 68841 has been included in the list as well. The description is “Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculi, each.” The same description was used for a Category III code 0356T previously. Now the coding team needs to use the new code for the same service effective January 1, 2022.

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