New noteworthy optometry codes
Are you using these new optometric codes in your practice for fiscal year 2024?
“Overall, there are changes to ICD-10-CM that are beneficial for doctors of optometry, while the CPT® changes are few for 2024,” says Rebecca Wartman, O.D., chair of the AOA Coding and Reimbursement Committee. “The biggest change for CPT is in the times attached to the E/M codes for use in office. This change was made to bring the times in line with the Centers for Medicare & Medicaid Services guidelines. The most disappointing change was CMS’ Final Physician Fee Schedule decrease in reimbursement amounts across the board.
“The AOA is lobbying Congress to finally fix the issues that surround the Medicare reimbursements year after year,” Dr. Wartman adds. “The large cuts we face in light of inflation over the past year would present grave difficulties for doctors of optometry across the country."
With the threat of end-of-year Medicare pay cuts, the AOA is increasingly pressing Congress to act. The focus remains on advancing H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would give doctors of optometry and other physicians an annual, permanent inflationary Medicare payment update tied to the Medicare Economic Index. However, knowing that legislation would bring with it a hefty price tag and also that time is of the essence, the AOA is also pushing lawmakers on a “Plan B.” On the House side, H.R. 3674, Providing Relief and Stability for Medicare Patients Act of 2023, which would lessen Medicare pay cuts by increasing the Medicare Fee Schedule budget neutrality threshold, has cleared a key committee and is ready for floor action. On the Senate side, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which would, among other things, restore 1.25% of the cuts set for 2024, has also cleared a key committee hurdle and awaits further action in the upper chamber. With little time and much at stake, AOA doctors and students are urged to contact their U.S. Senate and House members on this important issue through the online AOA Action Center or by texting PAYMENT to 855.465.5124.
Read more about the decrease—down 3.4% for 2024—in the Physician Fee Schedule.
CPT changes begin Jan. 1, 2024, while ICD-10-CM changes were effective Oct. 1 and include:
CPT code changes
The section on office-based evaluation and management (E/M) codes saw noteworthy changes to requirements regarding time thresholds when using time to determine the code level. Time ranges for office and other outpatient visit codes (99202-99205, 99212-99215) were dropped and were replaced with minimum times. The minimum times for each code are:
- 99202: 15 minutes must be met or exceeded.
- 99203: 30 minutes must be met or exceeded.
- 99204: 45 minutes must be met or exceeded.
- 99205: 60 minutes must be met or exceeded.
- 99211: Not applicable.
- 99212: 10 minutes must be met or exceeded.
- 99213: 20 minutes must be met or exceeded.
- 99214: 30 minutes must be met or exceeded.
- 99215: 40 minutes must be met or exceeded.
Further, E/M coding on split or shared visits was expanded to reflect a definition of “substantive portion,” as it applies to services provided jointly during visits by physicians and nonphysician practitioners in the same group. When time is used for the E/M code choice, the doctor who spent the most time with a patient, during a visit, would report the visit. If the code choice is based on the medical decision-making, the provider who made or approved the management plan for number and complexity of problems addressed at the encounter reports the service (effectively performing two of three elements of service).
Two new CPT III codes
- 0791T: Motor-cognitive, semi-immersive virtual reality–facilitated gait training, each 15 minutes.
- 0810T: Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies.
Also, a surgical code 67516 (suprachoroidal space injection of pharmacological agent) replaced 0465T.
New ICD-10-CM diagnosis codes
Chapter 7 of ICD-10-CM (Diseases of the Eye and Adnexa, H 00-H 59) includes 34 additions, including new codes for nonproliferative and proliferative sickle-cell retinopathy, mechanical strabismus codes describing which ocular muscle is affected, and for foreign body sensation of the eye.
The 2024 CPT manual will be the first edition to offer Spanish language descriptors for medical procedures and services. Many vision and medical plans and medical offices already incorporate CPT descriptors only in the English-language medical documents, insurance forms and patient portals. This expansion is intended to help patients who may have limited or no English proficiency.
AOA Marketplace contains key resources on coding:
2024 AOA Codes for Optometry Book & AOA Common ICD-10 Coding Card & AMA CPT Book: This ICD-10 coding bundle provides the tools needed for optometric professionals to code with confidence.
2024 AOA Codes for Optometry Book: This resource helps eye care professionals learn how to make correct decisions when selecting diagnosis codes, code modifiers and HCPCS codes—reflecting the expanding role of doctors of optometry in providing health care.
Member pricing is available.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.
The answer to this question, and more, from the AOA’s coding experts.