Ophthalmic staff need to be aware of these updates for 2022.

We have some new CPT codes to be aware of as of Jan. 1, 2022 as well as payment information on many of these new codes from the Centers for Medicare & Medicaid Services’ (CMS) recently released Final Rule of the 2022 Medicare Physician Fee Schedule.

Often, all that CPT releases is a temporary code number — we know a code is coming but not it’s final (usable) billing code for the following year; the CMS release gives us that last bit of information.

We need to be aware of three varieties of code change for 2022 use:

1. Combination codes (taking what has been billed with two separate codes and making a new code to represent both pieces; payment is now for the one and not two)
2. New and deleted codes
3. Code descriptor changes (the code remains, but the actual descriptor language changes).

Combination codes

Perhaps the biggest change is that we have a new combination code for cataract/IOL and a minimally invasive glaucoma surgery (MIGS) device insertion (eg, iStent [Glaukos] or Hydrus [Ivantis/Alcon]). In the past we had a cataract code (66984 or 66982) and a different code for the insertion of these devices. The cataract codes remain appropriate when you do “only” that. We have a new code for “complex” cataract with MIGS device and another for “regular” cataract with MIGS device:

• 66989. Extracapsular cataract removal w/IOL insertion, complex; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more
• 66991. Extracapsular cataract removal w/IOL insertion; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

A subtlety of the new combination codes is that they apply whether one of these devices is used or more than one. We no longer bill for the second device at all.

New and deleted codes

The code for using an iStent or Hydrus alone — without cataract surgery — is also different:

• 0671T. Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without extraocular reservoir, and without concomitant cataract removal, one or more

Be aware that the FDA approvals for these devices all currently say “with cataract surgery,” so even if you code this correctly it might not have insurance coverage and end up being patient pay. The code is also for one or more devices. You can’t use 0671T with 66984 — that code is now 66991 as noted above.

Importantly, our longstanding codes for iStent or Hydrus (0191T and 0376T) are both deleted and can no longer be used.

The only other new Category I code is:

• 68841. Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculi, each

There are some new Category III codes for use, but, in many cases, not much is known about their use yet:

• 0660T. Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach
• 0661T. Removal and reimplantation of anterior segment intraocular nonbiodegradable drug-eluting implant
• 0687T. Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session
• 0688T. Assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month
• 0699T. Injection, posterior chamber of the eye, medication (Note – this is the posterior chamber, not the posterior segment. It will go with the drug Dexycu, J code J1096)
• 0704T. Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment
• 0705T. Surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days
• 0706T. Interpretation and report by physician or other qualified health care professional, per calendar month

Code descriptor changes

We have some codes with different descriptor language in 2022. Here, the deleted language is marked in strikethrough and new language, if any, is underlined. Importantly, 67141 and 67145 had code language changes and become “minor surgeries” with 10-day global postoperative periods as of Jan. 1, 2022. In 2021, they were major surgeries with 90-day postoperative periods.

• 67141. Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; cryotherapy, diathermy
• 67145. Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation

The other changed descriptors are:

• 92065. Orthoptic and/or pleoptic training, with continuing medical direction and evaluation (Note: this will read only “orthoptic training”)
• 99211. Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.

CPT also made some other language changes to coding guidance that are important to know. Those are:

• (For destruction of localized lesion of choroid by transpupillary thermotherapy, use 67299)
• (For destruction of macular drusen, photocoagulation, use 67299)
• ▶ The anterior segment of the eye includes the cornea, lens, iris, and aqueous. The aqueous is divided into anterior and posterior chambers. The anterior chamber is by far the larger, including all of the aqueous in front of the lens and iris and behind the cornea. The posterior chamber includes the narrow area behind the iris and in front of the peripheral portion of the lens and lens zonules.

Other payment changes

While we can’t cover all the 2022 payment changes in this short article, we can discuss some general trends. Few codes eye doctors use went up in value for 2022, so this is a partial list of those with significant downward payments. The comments are related to when these surgeries are done in a facility such as an ambulatory surgery center or hospital outpatient department; in-office payments went down but by lesser amounts.

• Codes 67141 and 67145 will get less reimbursement for the surgeon. That’s partially because of the change to minor-surgery status. Remember that with a 10-day global, exams after this are now billable, which helps mitigate some of the decrease.
• Glaucoma surgery (including lasers) other than: a) aqueous shunts to an external reservoir, and b) trabeculectomy is down about 9% overall.
• Strabismus surgery codes 67311 and 67314 went down 20%, and 67312 is down 10%.
• Cataract surgery code 66984 is down another 4% after already taking cuts in the recent past.

Summary

There are many new and changed codes that affect us in eye care; be sure not to use deleted codes in 2022. Payment for codes could be different, too.

As always, “good coding to you.” OP

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