Ophthalmology and Optometry Coding Alert

Hint: You won’t find a code for the service in your manual.

If you see patients with dry eye conditions, chances are strong that your physician has performed a Schirmer’s test – but knowing whether to bill for this service can be a challenge. Check out the following three frequently-asked questions about the test.

FAQ 1: What’s the CPT^® Code for Schirmer’s Test?

Answer 1: CPT^® does not include a code for this procedure -- the Schirmer’s test is one of many diagnostic services that cannot be coded separately from an E/M code or eye code. A Schirmer’s test, or tear test, determines the amount of tears the eye produces. For patients with dry-eye syndrome, the test indicates whether the eye produces enough tears to keep it moist.

For the test, small filter paper strips are inserted into the conjunctival sacs of both eyes simultaneously for five minutes to measure tear production. Sometimes a topical anesthetic is administered prior to the paper insertion to prevent tearing from irritation caused by the paper. The eyes are closed during the test duration. At the test conclusion, the amount of moisture is measured.

FAQ 2: Can We Report 95060 for the Schirmer’s Test?

Answer: No, you cannot. CPT^® code 95060 (Ophthalmic mucous membrane tests) is listed in the allergy testing section of CPT^®. It’s used for mucous membrane testing and should not be applied for Schirmer’s tear testing.  

In fact, some payers have even excluded this specialty number for ophthalmology to avoid its misuse. Using 95060 would be considered misrepresenting the service, so you should avoid it when you’re billing for the Schirmer’s testing.

FAQ 3: Which ICD-10 Code Applies to This Service?

Answer: Base your ICD-10 code on your clinical findings, not the patient’s complaint. Example: If the patient complains of dry eyes with a foreign-body sensation, and you see diffuse punctate staining, punctate keratopathy, epithelial defects, sterile corneal ulcers, corneal vascularization, or corneal scarring in both eyes, then you might report H16.223 (Keratoconjunctivitis sicca, not specified as Sjogren’s, bilateral). But if a tear volume test reveals low tear volume, H04.123 (Dry eye syndrome of bilateral lacrimal glands) may be the appropriate choice.