We face changes to coding every year, and 2021 is no exception.

Q. What are coding changes this year?

A. The biggest change, of course, is to the evaluation and management (E/M) codes. Rather than selecting a code based on the number of history and exam elements, with medical decision making (MDM) a consideration, the new guidelines base E/M coding only on MDM or, alternatively, on total physician time. We’ll address changes to documentation requirements in another column, but be aware that 99201 has been deleted. Henceforth, there will be four E/M codes for new patients (99202 – 99205) and four for established patients (99211 – 99215).

There are no changes to the eye codes (920xx).

Q. What other changes are happening?

A. Remote imaging has become more crucial for telemedicine during the pandemic. There are two revised and one new code to help.

• 92227: REVISED Imaging of retina for detection or monitoring of disease; remote clinical staff review and report, unilateral or bilateral
• 92228: REVISED ... with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral
• 92229: NEW Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral

CPT 92229 is remote imaging via point-of-care automated analysis. CPT describes it as “augmented intelligence,” which means the software identifies unusual findings for a physician to review.

CPT 92227 and 92228 are not reportable in conjunction with 92133, 92134, 92228, 92229 or 92250. They are also mutually exclusive with one another.

Also for telemedicine, ophthalmology has new codes for remote imaging with OCT performed at home. These codes were effective July 1, 2020, so they aren’t completely new, but most practices are not aware of them.

• 0604T: NEW Optical coherence tomography (OCT) of retina, remote, patient-initiated image capture and transmission to a remote surveillance center, unilateral or bilateral; initial device provision, set-up and patient education on use of equipment
• 0605T: NEW ... remote surveillance center technical support, data analyses and reports, with a minimum of eight daily recordings, each 30 days
• 0606T: NEW ... review, interpretation and report by the prescribing physician or other QHP of remote surveillance center data analysis, each 30 days

Anterior segment ultrasound is no longer reportable per eye.

• 76513: REVISED Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral

There are new Category III codes as well. These new codes are used to report laser trabeculostomy, a new MIGS procedure currently in clinical trials.

• 0621T: NEW Trabeculostomy ab interno by laser
• 0622T: NEW Trabeculostomy ab interno by laser; with use of ophthalmic endoscope

There is a new add-on CPT code for prolonged physician services for exams. This allows for reporting time beyond E/M level 5 (99205, 99215) when the visit is coded based on physician time. Remember that each code has a range of time as part of its definition; this is a way to report additional time beyond that described in CPT.

• +99417: NEW Prolonged office or other outpatient E/M service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes of total time

CMS guidance is at odds with CPT, so CMS created a new HCPCS code. The difference between the two is the starting point for “prolonged services” — CPT uses minimum time for the code and CMS uses maximum time for the code.

• G2212: NEW Prolonged office or other outpatient E/M service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or QHP, with or without direct patient contact

Finally, a new code to report personal protective equipment costs was published in September 2020’s AMA CPT Assistant Special Edition (https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf )

• 99072: NEW Additional supplies, materials and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease

This sounds really helpful, if somewhat restrictive. Unfortunately, only a few private payers recognize it, and most don’t pay. The September CPT Assistant Special Edition reports that United Healthcare, for example, has said it will not recognize the code. Medicare treats PPE as incidental and bundles 99072 with other office services. OM

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .