The American Medical Association® updates the Current Procedural Terminology (CPT®) code set once a year. Fortunately, the 2022 CPT® code modifications (which go into effect on January 1, 2022) are minor, with only a few new codes and minor changes to the existing regulations and characteristics.
We’ll go over the different types of CPT® codes and the new or revised codes for optometry and ophthalmology procedures so you’re better prepared to charge medical insurance payers.
What are the CPT® Code Changes Expected in 2022?
The CPT® code set for 2022 contains 405 editorial modifications. There are 249 new codes, 63 removals, and 93 modifications. More than 40% of the changes made are related to further technical support in Category III CPT codes and the growth of the Proprietary Laboratory Analyses (PLA) codes. Furthermore, code changes implement to the COVID-19 vaccine reporting, monitoring, and management.
What is a CPT® Code?
The American Medical Association created CPT® codes in 1966 to explain medical, surgical, or diagnostic procedures physicians and healthcare providers performed. CPT® codes are needed for billing medical insurance payers and ensuring uniformity.
The AMA publishes CPT® codes, which are made up of numerous classifications of five-digit codes and two-character modifiers to explain any adjustments to the process. The codes may be numeric or alphabetic, and others may include a fifth alpha character, such as F, T, or U.
What is a CPT® Modifier?
Modifiers are appended to Healthcare Common Procedure Coding System (HCPCS) or CPT® codes to provide additional details for the claim processing. Modifiers explain why a doctor or other competent health professional performed a particular service or process. A hyphen denotes modifiers at the final moment of the CPT® code.
What are the Different Types of CPT® Codes?
Category I Codes: Explains services, processes, gadgets, and drugs (including vaccines) typically sub-categorized.
Category II Codes: These alphanumeric supplemental codes record follow-up treatment and results for measuring performance purposes, such as whether or not the patient smokes. These codes have no bearing on reimbursement.
Category III Codes: These are alphanumeric codes used when a doctor employs a new and emerging innovation, process, or service. According to the AMA, Category III codes were created for data gathering, evaluation, and payment of new services and treatments that presently do not fit a Category I code requirements.
Proprietary Laboratory Analyses (PLA) Codes: PLA codes are an alphanumeric CPT® code arranged by the AMA CPT® Editorial Panel recently added to explain proprietary clinical laboratory assessments. PLA codes have included a descriptor that can be used to recognize tests for particular labs or manufacturers.
What Have CPT® Codes Been Added for 2022?
Remote Therapeutic Monitoring
There are five new CPT codes: 98975, 98976, 98977, 98980, and 98981 to notify remote therapeutic monitoring. According to the AMA, these new CPT codes “broaden on remote physiologic tracking codes formed in 2020 (99453, 99454, 99457, and 99458).”
A new taxonomy code set (Appendix R – Digital Medicine – Services Taxonomy) supports multidimensional electronic medicine solutions in the categories listed below:
- Clinician-to-patient care.
- Clinician-to-clinician communication.
- Services for monitoring patients.
- Services for digital diagnostics.
PRO TIP: Make sure that simultaneous services include engaging in two-way real-time interactions between both parties simultaneously (audio/video required). Asynchronous solutions, such as interacting via phone, patient experience, or secure emails, do not necessitate live conversations and are store-and-forward transmissions.
Primary Care Management
The CPT Editorial Panel developed four new codes (99424, 99425, 99426, and 99427) to enable competent health professionals to report care management services to patients with a particular chronic condition. Previously, patients with multiple health conditions were repaid for these offerings. According to the AMA, the new codes better comply with Medicare guidelines.
Drug-eluting Implant Procedure
Code 68841 is a new addition that describes a drug-eluting implant process that involves the eye. “Integration of drug-eluting implants, such as punctual dilation when conducted, into lacrimal canaliculus, each,” says the descriptor for 68841. On January 1, 2022, code 68411 will replace Category III code 0356T, and the AMA will delete code 0356T.
PRO TIP: When a corticosteroid insert is positioned into the canaliculus to produce dexamethasone to cure pain and swelling after eye surgery, use code 68841.
Which CPT® Codes Have Been Revised for 2022?
99211 code: “Usually, the presenting issue(s) are minimal,” according to 99211. The new signifier for 99211 is “office or another outpatient visit for the evaluation and management of an established patient, which may or may not require the addition of a physician or other competent healthcare practitioner.”
92065 code: CPT Code 92065 denotes orthoptic training (vision therapy) performed in the office under the supervision of a doctor. Always double-check benefit plan explanations because some insurance plans do not cover vision therapy.
67141 and 67145 codes:
In the prophylaxis section, these two retinal detachment codes were modified. According to 2022 Medicare Physician Fee Schedule Proposed Rule published on July 23, 2021, the codes were changed to remove references to “1 or more sessions” so that the offerings could be valued as a 10-day procedure rather than the current 90-day worldwide.
67141: “one or more sessions” was excluded from the descriptor. Prophylaxis or retinal detachment (e.g., retinal break, lattice degeneration) without drainage, cryotherapy, or diathermy, according to the new descriptor.
67145: “one or more sessions” and “(laser or xenon arc)” were excluded from the descriptor. “Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage; photocoagulation,” according to the new descriptor.
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Keeping up with ever-changing optometry and ophthalmology medical billing rules, CPT® and ICD-10 code changes, insurance payer and handled vision plan demands, complex processes, and managing denied and rejected claims. Billing executive solutions have an expert knowledge in medical billing and coding. Contact us right away at firstname.lastname@example.org for your concerns.
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