New Codes for Retinal Imaging, Effective 1/1/2011

Three new codes will replace 92135

2011 Current Procedural Terminology (CPT©, American Medical Association) includes one very significant change affecting eye care.  92135, "Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg scanning laser) with interpretation and report, unilateral," has been eliminated.  In turn, CPT has created three new codes for imaging.  The following codes will be in effect January 1, 2011:

92132 - Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (Replaces the CPT Category III code, 0187T)

92133 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve

92134 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina

Caveats to consider:  92135 was billed once per eye. Each of the imaging new codes is billed once, whether one eye or both eyes are scanned. 92132 may be billed on the same day as either 92133 or 92134, assuming the diagnoses involved with the visit support doing both procedures. 92133 and 92134 are mutually exclusive and cannot be billed on the same day, regardless of diagnosis

National average Medicare allowable payments for the new imaging codes during 2011 and relatives value units (RVUs) assigned the codes under Medicare's Resource-Based Relative Value Scale are as follows:

92132 - RVU: 1.07; Medicare allowable: $38.59
92133 - RVU: 1.31; Medicare allowable: $47.25
92134 - RVU: 1.31; Medicare allowable: $47.25

(The above indicated national average allowable reimbursements are based on the Medicare 2011 conversion factor of $36.07. They do not reflect geographic payment adjustments or other factors which might impact reimbursements.)

Watch AOA News, the AOA Web site (www.aoa.org), AOAConnect, and AOACodingToday (www.aoacodingtoday.com) for updates on this subject. AOA members with specific questions on the new imaging codes may consult AOA's Ask the Coding Expert service at askthecodingexpert@aoa.org