Two new codes became effective July 1.

CPT codes are released twice a year. Specifically, Category III codes, or temporary codes, have release dates in January and July. In some years, the “mid-year” release does not affect eye care, while in other years, as is the case this year, one or more codes are released that you need to know about and use.

What is a Category III code?

When a CPT or ICD-10 code is released, it must be used if it is active on the date of service and it accurately describes the service (test, surgery, or other service) your office delivered. When Category I codes are new they go “active” on Jan. 1, so there is never a danger that you will buy a book and miss one of these. When Category III codes are released mid-year, however, they might not show up in your CPT books for an entire publishing cycle. A previous OP Coding article from last year discussed the differences in CPT code types (see bit.ly/March17OP ). We noted then that the Category III Section Overview in every CPT book states: “If a Category III code is available, this code must be reported instead of a Category I unlisted code.”

Where do these codes originate?

When there is a new instrument that uses new technology — or older technology in a novel way — the manufacturer has often applied for use in the United States and gotten a Category III CPT code.

What codes were released this year?

The two new “mid-year” release codes that went active on July 1 and also affect eye care are¹:

• 0506T. Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report. You may hear, or have already heard, about an instrument that performs macular pigment optical density, or “flicker photometry” testing. This measures the effectiveness of the treatment of non-exudative macular degeneration with ocular nutritional supplements via the use of flicker testing of macular pigments — lutein, zeaxanthin, and the metabolite meso-zeaxanthin — over time.^2,3 If this test had come out in the past, you might have selected 92499 (unlisted ophthalmological service) when coding for it. There might have been insurance coverage since payers may not have known what it was. Now, with the 0506T code, coverage is very unlikely and the patient is therefore responsible for payment.
• 0507T. Near infrared dual imaging (i.e., simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report. This new code applies to something that has been available from a number of U.S. instrument manufacturers. You may know it as “meibomian gland photography” or “meibography.” When this is done via infrared imaging, 0507T now applies. In the past, there was controversy about whether to use 92285 (external ocular photography) or 92499. (Additionally, 0330T is appropriate for imaging the tear film.) Use of these codes might have had insurance coverage, but as noted above, 0507T, as a new code, is unlikely to have coverage. As such, the patient would be responsible for payment to the office for this test.

Conclusion

When codes released in the middle of the year go active, you need to use them. Check coverage, as new codes may not be paid by insurance. It is important to stay current so you don’t choose an older, now invalid, code and inadvertently ask the wrong party to pay.

As always, “good coding to you.” OP

REFERENCES:

1. American Medical Association. CPT Category III Codes. Most recent changes. Latest update June 27, 2018. https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/cpt/cpt-category3-codes-long-descriptors.pdf . Accessed July 25, 2018.
2. Stringham JM, Hammond BR, Nolan JM, et al. The utility of using customized heterochromatic flicker photometry (cHFP) to measure macular pigment in patients with age-related macular degeneration. Exp Eye Res. 2008 Nov;87(5):445-53. doi: 10.1016/j.exer.2008.08.005.
3. Ma, L., Lui R., Du JH, et. al. Lutein, Zeaxanthin and Meso-zeaxanthin Supplementation Associates with Macular Pigment Optical Density, Nutrient. 2016 Jul 12;8(7). doi: 10.3390/nu8070426.

Mr. Larson is a senior consultant at Corcoran Consulting Group. He specializes in coding and reimbursement. Mr. Larson is based in Atlanta.