Midyear Category III CPT code updates sometimes get overlooked, but that's a mistake you don't want to make. The CPT® rule is very clear: "If a Category III code is available, this code must be reported instead of a Category I unlisted code." For all of you ophthalmology coders, here are four new Category III codes to get to know before their July 1 effective date.
Apply 0469T for Retinal Polarization Scan
Effective July 1, 2017, you'll be able to report 0469T (Retinal polarization scan, ocular screening with on-site automated results, bilateral).
Be sure to catch that the code descriptor specifies it applies to bilateral services. That means you should not append modifier 50 (Bilateral procedure) when you perform the service on both eyes.
Important: This Category III code comes with two parenthetical notes to help keep your coding clean.
First, CPT® instructs you not to report this new code together with 92002-92014, which are the codes for general ophthalmological services and procedures.
Second, CPT® reminds you that you have more appropriate codes for ocular photoscreening:
- 99174 (Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral; with remote analysis and report)
- 99177 (… with on-site analysis).
Pick 0472T or 0473T for Retinal Electrode Array Eval
If you perform services related to intra-ocular retinal electrode arrays, be sure to catch these two new codes:
- 0472T (Device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional)
- 0473T (Device evaluation and interrogation of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional).
Tip: The code descriptors look similar at first glance, but with a closer read you'll see that 0472T is appropriate for initial programming and 0473T is for reprogramming.
Focus on 0474T for Supraciliary Aqueous Drainage
Effective July 1, a new option will be joining your other choices for aqueous drainage device insertion codes. The new code is 0474T (Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space).
This new code has requirements in common with other Category III codes you may be familiar with already (like 0191T, 0253T, and 0376T). Similarities include the insertion into the anterior segment and the internal approach.
But the 0474T code descriptor specifies the service involves the supraciliary space and uses the phrase “with creation of intraocular reservoir,” separating this new code from the rest of the pack.
Here's a Category III Refresher and Action Plan
Category I CPT® medical procedure codes see updates on January 1, but Category III codes see updates in both January and July. As CPT® states, Category III codes describe "emerging technology, services, procedures, and service paradigms," and these more frequent updates make it easier for coding to keep pace with innovation.
One of the common complaints about Category III codes is that getting third-party payers to cover them is difficult. These are cutting edge services that payers may deem investigational and therefore noncovered. But don't assume you won't receive payment. Payers do cover some Category III codes.
If the code isn't covered, remember that you shouldn't report an unlisted procedure code, like 66999 (Unlisted procedure, anterior segment of eye), to try to get payment. As stated above, not using a Category III code when available is incorrect coding. If you perform a service described by a Category III code, you should report the appropriate code and consider it an investment in your future. Reporting a Category III code, which is a temporary code, assists with data collection regarding real-world use of the service or procedure. That information may help support a decision to replace the Category III code with a more permanent Category I code. Code reporting data also may prove useful during the FDA approval process for devices or drugs related to the code.
Final tip: Because of the publishing schedule, you can't count on a hard copy CPT® manual to have the complete list of Category III codes effective either January 1 or July 1. Think ahead to be sure you don't miss any Category III code additions, revisions, or deletions that are important to you. Check the AMA's CPT® Category III Codes website to review the updates to these CPT® codes online, or make sure that your online CPT® lookup tool tracks Category III updates and makes them available as part of the CPT® code search on the effective date.
Deborah Marsh, JD, MA, CPC, CHONC is a Coding Content Writer/Editor for Supercoder. Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she's also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more. Deborah earned a bachelor's degree from Harvard University and law and master's degrees from Duke University. She received her Certified Professional Coder® (CPC®) certification from AAPC in 2004 and her Certified Hematology and Oncology Coder™ (CHONC™) credential in 2010.